Provider Demographics
NPI:1437892643
Name:COUCH, DIONTE TAMIKA (LPN)
Entity Type:Individual
Prefix:
First Name:DIONTE
Middle Name:TAMIKA
Last Name:COUCH
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 1:13639 SHADY OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-6030
Mailing Address - Country:US
Mailing Address - Phone:216-965-4138
Mailing Address - Fax:
Practice Address - Street 1:8101 EUCLID AVE STE 201
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-5059
Practice Address - Country:US
Practice Address - Phone:216-220-0035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.178715.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse