MEDICARE: MRS. ASHIRA LASDUN APN-C

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	363L00000X	Nurse Practitioner	26NJ00344800	NJ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ00344800	NJ

General Provider Information

NPI Number	:	1467727008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHIRA LASDUN APN-C

Provider Business Mailing Address
First Line	:	18 NATURES WAY
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4339
Country	:	US
Telephone Number	:	732-534-1378
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 RIVER AVE STE 200
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4719
Country	:	US
Telephone Number	:	732-884-1800
Fax Number	:

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

Provider Enumeration Date	:	03/15/2012
Last Update Date	:	02/14/2024

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