Provider Demographics
NPI:1396063905
Name:GOODING, TAWANA M'ANTAY (LPN)
Entity type:Individual
Prefix:MRS
First Name:TAWANA
Middle Name:M'ANTAY
Last Name:GOODING
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 1:412 MCCREARY CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-4021
Mailing Address - Country:US
Mailing Address - Phone:513-485-8252
Mailing Address - Fax:
Practice Address - Street 1:412 MCCREARY CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-4021
Practice Address - Country:US
Practice Address - Phone:513-485-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN132918M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse