MEDICARE: LASHONDA NICOLE HARRIS LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	148599	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	148599	OTHER	OH	OHIO BOARD OF NURSING

General Provider Information

NPI Number	:	1043558174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHONDA NICOLE HARRIS LPN

Provider Business Mailing Address
First Line	:	2901 E 102ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-4972
Country	:	US
Telephone Number	:	216-566-4478
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 E 102ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-4972
Country	:	US
Telephone Number	:	216-566-4478
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2013
Last Update Date	:	01/24/2013

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