MEDICARE: LASHAWANDA MONIQUE HUDSON 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	251E00000X	Home Health Agency
2	251J00000X	Nursing Care Agency
3	164W00000X	Licensed Practical Nurse	LPN143681	OH

General Provider Information

NPI Number	:	1104888551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHAWANDA MONIQUE HUDSON LPN

Provider Business Mailing Address
First Line	:	831 E 249TH ST
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-2376
Country	:	US
Telephone Number	:	440-682-0454
Fax Number	:

Provider Business Practice Location Address
First Line	:	831 E 249TH ST
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123
Country	:	US
Telephone Number	:	440-682-0454
Fax Number	:

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	06/18/2018

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