Provider Demographics
NPI:1730925876
Name:TATUM, LANICE
Entity type:Individual
Prefix:
First Name:LANICE
Middle Name:
Last Name:TATUM
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 1:987 SNOWFALL SPUR APT B
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-8909
Mailing Address - Country:US
Mailing Address - Phone:406-970-5186
Mailing Address - Fax:
Practice Address - Street 1:987 SNOWFALL SPUR APT B
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-8909
Practice Address - Country:US
Practice Address - Phone:406-970-5186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker