Provider Demographics
NPI:1962813659
Name:STATEN, TASHAWNA (LPN)
Entity Type:Individual
Prefix:
First Name:TASHAWNA
Middle Name:
Last Name:STATEN
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 1:2432 WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-1733
Mailing Address - Country:US
Mailing Address - Phone:937-715-7002
Mailing Address - Fax:
Practice Address - Street 1:2432 WHEELER AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1733
Practice Address - Country:US
Practice Address - Phone:937-715-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN153150164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse