Provider Demographics
NPI:1457641078
Name:BENGE, TAMELA ANNELLE (LPN)
Entity Type:Individual
Prefix:
First Name:TAMELA
Middle Name:ANNELLE
Last Name:BENGE
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 1:6387 LIBERTY FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-5151
Mailing Address - Country:US
Mailing Address - Phone:513-844-8467
Mailing Address - Fax:
Practice Address - Street 1:6387 LIBERTY FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45011-5151
Practice Address - Country:US
Practice Address - Phone:513-844-8467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-16
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH130524164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse