Healthcare Provider Details

I. General information

NPI: 1881918597
Provider Name (Legal Business Name): TISHA RENEE' CREW LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 11/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8755 PLANET DR
CINCINNATI OH
45231-4130
US

IV. Provider business mailing address

8755 PLANET DR
CINCINNATI OH
45231-4130
US

V. Phone/Fax

Practice location:
  • Phone: 513-739-1864
  • Fax:
Mailing address:
  • Phone: 513-739-1864
  • 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 Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN125222IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: