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General NPI Number Information
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NPI Number | 1962570804
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Entity Type | Individual
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Provider Name | TANJA MCCOY LPN
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Gender | Female
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1630 2 EAST MAIN STREET
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City | LOUISVILLE
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State | OH
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Zip | 44641
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Country | US
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Telephone | 216-215-0919
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 18648
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City | CLEVELAND HTS
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State | OH
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Zip | 44118-0648
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Country | US
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Telephone | 216-215-0919
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Fax | 216-583-9003
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN079519
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License Number State | OH
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