Provider Demographics
NPI:1114598448
Name:NICKENS, LASHAWN
Entity Type:Individual
Prefix:
First Name:LASHAWN
Middle Name:
Last Name:NICKENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 NAVY DAY DR
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-2120
Mailing Address - Country:US
Mailing Address - Phone:240-462-2282
Mailing Address - Fax:
Practice Address - Street 1:125 ELMIRA ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2266
Practice Address - Country:US
Practice Address - Phone:202-230-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant