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NPI Code Detail

MEDICARE: LASONJI DONIKA SOUTHALL OWNER/CEO

MEDICARE: LASONJI DONIKA SOUTHALL OWNER/CEO
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
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1841864584
Entity Type Code : Individual
Provider Name (Legal Business Name) : LASONJI DONIKA SOUTHALL OWNER/CEO
Provider Business Mailing Address
First Line : 128 W DEWEY ST
Second Line :
City : FLINT
State : MI
Zip : 48505-4034
Country : US
Telephone Number : 810-931-8722
Fax Number :
Provider Business Practice Location Address
First Line : 128 W DEWEY ST
Second Line :
City : FLINT
State : MI
Zip : 48505-4034
Country : US
Telephone Number : 810-931-8722
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2021
Last Update Date : 05/17/2021

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Directions to “ LASONJI DONIKA SOUTHALL OWNER/CEO” Practice Location

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