Provider Demographics
NPI:1790975209
Name:LEE, TIRA SHENEA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:TIRA
Middle Name:SHENEA
Last Name:LEE
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 1:5675 SANDALWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-4327
Mailing Address - Country:US
Mailing Address - Phone:614-354-9635
Mailing Address - Fax:
Practice Address - Street 1:5675 SANDALWOOD BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-4327
Practice Address - Country:US
Practice Address - Phone:614-354-9635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 125684 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse