MEDICARE: LAKIA CHOICE

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	128778	OH

General Provider Information

NPI Number	:	1437494838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKIA CHOICE

Provider Business Mailing Address
First Line	:	2305 PINECREST DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2833
Country	:	US
Telephone Number	:	614-598-7261
Fax Number	:

Provider Business Practice Location Address
First Line	:	2305 PINECREST DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2833
Country	:	US
Telephone Number	:	614-598-7261
Fax Number	:

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

Provider Enumeration Date	:	12/11/2012
Last Update Date	:	12/11/2012

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Directions to “ LAKIA CHOICE ” Practice Location

Language	Start Address	Practice Location

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