=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578157921
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LASHARI M E HEYWARD CPT, CPI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2021
-----------------------------------------------------
Last Update Date | 02/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 731 BRICKSTON RD
-----------------------------------------------------
City | REISTERSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21136-6401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-712-3311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 731 BRICKSTON RD
-----------------------------------------------------
City | REISTERSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21136-6401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-712-3311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246RP1900X
-----------------------------------------------------
Taxonomy Name | Phlebotomy Technician
-----------------------------------------------------
License Number | 20-1731
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------