Healthcare Provider Details

I. General information

NPI: 1659978898
Provider Name (Legal Business Name): LANIKA TRAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3094 W MARKET ST STE 343
FAIRLAWN OH
44333-3626
US

IV. Provider business mailing address

3200 FOXFORD CT
AKRON OH
44312-4654
US

V. Phone/Fax

Practice location:
  • Phone: 234-334-5589
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: