Provider Demographics
NPI:1679826531
Name:MAUL, TEAIRA (LPN)
Entity Type:Individual
Prefix:
First Name:TEAIRA
Middle Name:
Last Name:MAUL
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 1:2731 E TOWER DR
Mailing Address - Street 2:APT #212
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-6441
Mailing Address - Country:US
Mailing Address - Phone:513-485-1971
Mailing Address - Fax:
Practice Address - Street 1:2731 E TOWER DR
Practice Address - Street 2:APT #212
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-6441
Practice Address - Country:US
Practice Address - Phone:513-485-1971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN134400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse