Healthcare Provider Details

I. General information

NPI: 1023725751
Provider Name (Legal Business Name): TEASHA TENNYSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 EDALBERT DR
CINCINNATI OH
45239-7604
US

IV. Provider business mailing address

3247 MIDDEN CIR
CINCINNATI OH
45238-2204
US

V. Phone/Fax

Practice location:
  • Phone: 513-878-5820
  • Fax:
Mailing address:
  • Phone: 513-878-5820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: