MEDICARE: KASHINA MINOR LPN

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	164W00000X	Licensed Practical Nurse	LPN.170115	OH

General Provider Information

NPI Number	:	1083268379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASHINA MINOR LPN

Provider Business Mailing Address
First Line	:	464 RICHMOND RD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-2792
Country	:	US
Telephone Number	:	216-298-7384
Fax Number	:

Provider Business Practice Location Address
First Line	:	464 RICHMOND RD STE 202
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-2704
Country	:	US
Telephone Number	:	440-479-2236
Fax Number	:

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

Provider Enumeration Date	:	07/25/2019
Last Update Date	:	06/25/2021

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