Provider Demographics
NPI:1154824662
Name:TATUM, LASHANDA RENEE (LPN)
Entity Type:Individual
Prefix:
First Name:LASHANDA
Middle Name:RENEE
Last Name:TATUM
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 1:6269 STOVER AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-4825
Mailing Address - Country:US
Mailing Address - Phone:513-393-0912
Mailing Address - Fax:
Practice Address - Street 1:6269 STOVER AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-4825
Practice Address - Country:US
Practice Address - Phone:513-393-0912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-10
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.154239164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
10085683OtherINTEGRITY HOME HEALTH CARE