Provider Demographics
NPI:1689161093
Name:KRAHENBUHL, TAWNYA LYNN (LPN)
Entity type:Individual
Prefix:
First Name:TAWNYA
Middle Name:LYNN
Last Name:KRAHENBUHL
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 1:106 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:OH
Mailing Address - Zip Code:44217-9602
Mailing Address - Country:US
Mailing Address - Phone:330-317-8753
Mailing Address - Fax:
Practice Address - Street 1:106 CARTER ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:OH
Practice Address - Zip Code:44217-9602
Practice Address - Country:US
Practice Address - Phone:330-317-8753
Practice Address - Fax:234-678-6919
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH105388164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0099305Medicaid