MEDICARE: MS. LAKISHA SHERRA HOOKS 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	PN.125798	OH

General Provider Information

NPI Number	:	1699913400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAKISHA SHERRA HOOKS LPN

Provider Business Mailing Address
First Line	:	860 CLARENCE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1306
Country	:	US
Telephone Number	:	216-255-1631
Fax Number	:	216-382-3646

Provider Business Practice Location Address
First Line	:	860 CLARENCE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1306
Country	:	US
Telephone Number	:	216-255-1631
Fax Number	:	216-382-3646

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

Provider Enumeration Date	:	02/02/2009
Last Update Date	:	02/06/2009

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