Provider Demographics
NPI:1861719965
Name:AVERY, TARESA LOU'NEE (RN)
Entity type:Individual
Prefix:
First Name:TARESA
Middle Name:LOU'NEE
Last Name:AVERY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TARESA
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:375 GLENSPRINGS DR STE 410
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2316
Mailing Address - Country:US
Mailing Address - Phone:151-338-7974
Mailing Address - Fax:513-882-3422
Practice Address - Street 1:155 NORTHLAND BLVD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3121
Practice Address - Country:US
Practice Address - Phone:513-400-9006
Practice Address - Fax:513-386-8730
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN396147163WC1600X, 163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development