Provider Demographics
NPI:1992925408
Name:BAINES-TAGGART, SANDRA AMARA (LPN)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:AMARA
Last Name:BAINES-TAGGART
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 1:3076 GLENAIRE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-2610
Mailing Address - Country:US
Mailing Address - Phone:513-742-1799
Mailing Address - Fax:
Practice Address - Street 1:3076 GLENAIRE DR.
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-2610
Practice Address - Country:US
Practice Address - Phone:513-742-1799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN030455164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2201923Medicaid