Provider Demographics
NPI:1265710792
Name:BING, TIAVONNA LACHELLE (LPN)
Entity type:Individual
Prefix:
First Name:TIAVONNA
Middle Name:LACHELLE
Last Name:BING
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 1:512 SOUTHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1375
Mailing Address - Country:US
Mailing Address - Phone:614-795-9630
Mailing Address - Fax:
Practice Address - Street 1:512 SOUTHWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1375
Practice Address - Country:US
Practice Address - Phone:614-795-9630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.142921-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse