Healthcare Provider Details

I. General information

NPI: 1285416644
Provider Name (Legal Business Name): RONDA SUE TYO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67670 TRACO DR
SAINT CLAIRSVILLE OH
43950-9375
US

IV. Provider business mailing address

38 EVERGREEN LN
WHEELING WV
26003-4944
US

V. Phone/Fax

Practice location:
  • Phone: 740-695-2131
  • Fax:
Mailing address:
  • Phone: 304-559-1610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN.354361
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: