Provider Demographics
NPI:1528351517
Name:COUCH, TAMARA DAWN (LPN)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:DAWN
Last Name:COUCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7427 BROOKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-2988
Mailing Address - Country:US
Mailing Address - Phone:513-884-6489
Mailing Address - Fax:
Practice Address - Street 1:7427 BROOKSTONE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-2988
Practice Address - Country:US
Practice Address - Phone:513-884-6489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.104043-MEDS164W00000X
372500000X, 372600000X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide