Individual
MRS. TINA MARIE LIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
24651 280TH ST., WAUCOMA, IA 52171
(563) 776-9541
Mailing address
24651 280TH ST., WAUCOMA, IA 52171
(563) 776-9541
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
08/09/2019
Last updated
08/09/2019
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