Healthcare Provider Details

I. General information

NPI: 1073116281
Provider Name (Legal Business Name): MRS. TANYA E LIGON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. TANYA E LIGON

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18400 HAZELWOOD AVE
MAPLE HEIGHTS OH
44137-3535
US

IV. Provider business mailing address

18400 HAZELWOOD AVE
MAPLE HEIGHTS OH
44137-3535
US

V. Phone/Fax

Practice location:
  • Phone: 216-315-7046
  • Fax:
Mailing address:
  • Phone: 216-315-7046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number37782641298
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: