Provider Demographics
NPI:1871195834
Name:SMITH, TAMARA DONICE (LPN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:DONICE
Last Name:SMITH
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 1:2784 CREST RD
Mailing Address - Street 2:
Mailing Address - City:COLERAIN TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45251-4605
Mailing Address - Country:US
Mailing Address - Phone:513-923-6001
Mailing Address - Fax:
Practice Address - Street 1:2784 CREST RD
Practice Address - Street 2:
Practice Address - City:COLERAIN TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45251-4605
Practice Address - Country:US
Practice Address - Phone:513-923-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH158831164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse