Healthcare Provider Details

I. General information

NPI: 1104888551
Provider Name (Legal Business Name): LASHAWANDA MONIQUE HUDSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 E 249TH ST
EUCLID OH
44123
US

IV. Provider business mailing address

831 E 249TH ST
EUCLID OH
44123-2376
US

V. Phone/Fax

Practice location:
  • Phone: 440-682-0454
  • Fax:
Mailing address:
  • Phone: 440-682-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN143681
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: