Provider Demographics
NPI:1730817347
Name:STRONG, ILIVEA B (LPN)
Entity type:Individual
Prefix:
First Name:ILIVEA
Middle Name:B
Last Name:STRONG
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 1:4337 VALENCE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-5824
Mailing Address - Country:US
Mailing Address - Phone:706-714-0141
Mailing Address - Fax:
Practice Address - Street 1:1820 RUTLAND AVE APT 401
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45207-1247
Practice Address - Country:US
Practice Address - Phone:703-944-8280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH180675164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse