MEDICARE: LASHANNA ANTOINETTE THOMPSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	250185741	IN

General Provider Information

NPI Number	:	1053125559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHANNA ANTOINETTE THOMPSON

Provider Business Mailing Address
First Line	:	9664 GULL LAKE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-6892
Country	:	US
Telephone Number	:	317-250-9829
Fax Number	:

Provider Business Practice Location Address
First Line	:	9664 GULL LAKE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-6892
Country	:	US
Telephone Number	:	317-250-9829
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2025
Last Update Date	:	02/04/2025

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Directions to “ LASHANNA ANTOINETTE THOMPSON ” Practice Location

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