Provider Demographics
NPI:1366792012
Name:SLONE, TARA (LPN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:SLONE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 KYBER RUN CIR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-9616
Mailing Address - Country:US
Mailing Address - Phone:614-570-0879
Mailing Address - Fax:
Practice Address - Street 1:323 KYBER RUN CIR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031-9616
Practice Address - Country:US
Practice Address - Phone:614-570-0879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 129273 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse