Healthcare Provider Details

I. General information

NPI: 1427820984
Provider Name (Legal Business Name): TAMARAH LENISE WYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10606 MORNING GLORY LN
CINCINNATI OH
45240-4015
US

IV. Provider business mailing address

9748 WAYNE AVE
CINCINNATI OH
45215-2257
US

V. Phone/Fax

Practice location:
  • Phone: 513-493-8552
  • Fax:
Mailing address:
  • Phone: 513-813-6341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: