Provider Demographics
NPI:1326632159
Name:RAVEN, TAMIKA LASHAWNA
Entity Type:Individual
Prefix:MS
First Name:TAMIKA
Middle Name:LASHAWNA
Last Name:RAVEN
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 1:10619 DEAUVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-4004
Mailing Address - Country:US
Mailing Address - Phone:513-276-2439
Mailing Address - Fax:
Practice Address - Street 1:10619 DEAUVILLE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-4004
Practice Address - Country:US
Practice Address - Phone:513-276-2439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide