Healthcare Provider Details

I. General information

NPI: 1720459779
Provider Name (Legal Business Name): LAWANDA LAKISHA MORROW LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAWANDA LAKISHA MORROW LPN

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E NAPIER AVE APT C3
BENTON HARBOR MI
49022-6128
US

IV. Provider business mailing address

777 E NAPIER AVE APT C3
BENTON HARBOR MI
49022-6128
US

V. Phone/Fax

Practice location:
  • Phone: 269-252-8464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703105064
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: