Healthcare Provider Details

I. General information

NPI: 1861719965
Provider Name (Legal Business Name): TARESA LOU'NEE AVERY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARESA ANDERSON

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 NORTHLAND BLVD
CINCINNATI OH
45246-3121
US

IV. Provider business mailing address

375 GLENSPRINGS DR STE 410
CINCINNATI OH
45246-2316
US

V. Phone/Fax

Practice location:
  • Phone: 513-400-9006
  • Fax: 513-386-8730
Mailing address:
  • Phone: 151-338-7974
  • Fax: 513-882-3422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberRN396147
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: