Provider Demographics
NPI:1881918597
Name:CREW, TISHA RENEE' (LPN)
Entity type:Individual
Prefix:
First Name:TISHA
Middle Name:RENEE'
Last Name:CREW
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 1:8755 PLANET DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-4130
Mailing Address - Country:US
Mailing Address - Phone:513-739-1864
Mailing Address - Fax:
Practice Address - Street 1:8755 PLANET DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-4130
Practice Address - Country:US
Practice Address - Phone:513-739-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN125222IV164W00000X
372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No372600000XNursing Service Related ProvidersAdult Companion