MEDICARE: LASANDRA KINDRED 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	142393-M-IV	OH

General Provider Information

NPI Number	:	1619396777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASANDRA KINDRED LPN

Provider Business Mailing Address
First Line	:	21101 CLARE AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21101 CLARE AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2413
Country	:	US
Telephone Number	:	216-315-2816
Fax Number	:

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

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	04/15/2014

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