Provider Demographics
NPI:1023628195
Name:TINNEY, ROSA
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:TINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 JOHNSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26261-1313
Mailing Address - Country:US
Mailing Address - Phone:304-846-4595
Mailing Address - Fax:
Practice Address - Street 1:259 JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:WV
Practice Address - Zip Code:26261-1313
Practice Address - Country:US
Practice Address - Phone:304-846-4595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant