Individual
MS. TANYA R. HULLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
STNA
Contact information
Practice address
1861 W 58TH ST, CLEVELAND, OH 44102-3252
(216) 536-1712
Mailing address
1861 W 58TH ST, CLEVELAND, OH 44102-3252
(216) 536-1712
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
376978051197
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3134370
—
OH
Enumeration date
06/16/2011
Last updated
06/16/2011
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