Healthcare Provider Details

I. General information

NPI: 1396202412
Provider Name (Legal Business Name): TAMMY A KLINEFELTER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 W MARKET ST
WARREN OH
44485-3069
US

IV. Provider business mailing address

320 HIGH ST NE
WARREN OH
44481-1222
US

V. Phone/Fax

Practice location:
  • Phone: 330-898-6992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberLPN.087901
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: