Healthcare Provider Details

I. General information

NPI: 1306542477
Provider Name (Legal Business Name): LAKESHA EVETTE BRASBY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 OLD LANDING RD
MILLSBORO DE
19966-1210
US

IV. Provider business mailing address

803 MIAMI AVE
SALISBURY MD
21801-3012
US

V. Phone/Fax

Practice location:
  • Phone: 302-947-1920
  • Fax:
Mailing address:
  • Phone: 410-713-5098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP48655
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: