Provider Demographics
NPI:1477576908
Name:PRICE, TARA DENISE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:TARA
Middle Name:DENISE
Last Name:PRICE
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 1:7307 LAMSON RD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44146-5846
Mailing Address - Country:US
Mailing Address - Phone:440-232-1768
Mailing Address - Fax:440-232-1768
Practice Address - Street 1:7307 LAMSON RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44146-5846
Practice Address - Country:US
Practice Address - Phone:440-232-1768
Practice Address - Fax:440-232-1768
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN103887164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2185737Medicaid