Provider Demographics
NPI:1427464643
Name:HASAN, THEMBALENA
Entity type:Individual
Prefix:
First Name:THEMBALENA
Middle Name:
Last Name:HASAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7607 WILDBRANCH RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-7780
Mailing Address - Country:US
Mailing Address - Phone:513-714-4466
Mailing Address - Fax:
Practice Address - Street 1:7607 WILDBRANCH RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-7780
Practice Address - Country:US
Practice Address - Phone:513-714-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH501093610406171W00000X
OH5010936106376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3101161OtherSTATE OF OHIO PROVIDER NUMBER