Healthcare Provider Details

I. General information

NPI: 1821431487
Provider Name (Legal Business Name): TYRA D ESTIS-TOUNKARA STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2013
Last Update Date: 04/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 E 279TH ST #204-F
EUCLID OH
44132-3089
US

IV. Provider business mailing address

1341 E 279TH ST #204-F
EUCLID OH
44132-3089
US

V. Phone/Fax

Practice location:
  • Phone: 440-381-4977
  • Fax: 216-692-2293
Mailing address:
  • Phone: 440-381-4977
  • Fax: 216-692-2293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400579480107
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: