Provider Demographics
NPI:1093140394
Name:LUDORU, PONIJA LASSU (RN)
Entity Type:Individual
Prefix:MS
First Name:PONIJA
Middle Name:LASSU
Last Name:LUDORU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 GETTYSBURG LN
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-6900
Mailing Address - Country:US
Mailing Address - Phone:513-708-0465
Mailing Address - Fax:
Practice Address - Street 1:8417 GETTYSBURG LN
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-6900
Practice Address - Country:US
Practice Address - Phone:513-708-0465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN376890163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse