MEDICARE: LAKENDRIA MONIQUE POWELL

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1356974430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKENDRIA MONIQUE POWELL

Provider Business Mailing Address
First Line	:	26241 LAKE SHORE BLVD APT 1463
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44132-1145
Country	:	US
Telephone Number	:	216-394-3851
Fax Number	:

Provider Business Practice Location Address
First Line	:	1008 E 66TH PL
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-1606
Country	:	US
Telephone Number	:	216-269-7706
Fax Number	:

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

Provider Enumeration Date	:	02/18/2020
Last Update Date	:	02/18/2020

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