Provider Demographics
NPI:1154864478
Name:HIGDON, LAKEETA S (STNA)
Entity Type:Individual
Prefix:
First Name:LAKEETA
Middle Name:S
Last Name:HIGDON
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 NATHANIEL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-3233
Mailing Address - Country:US
Mailing Address - Phone:216-413-8496
Mailing Address - Fax:
Practice Address - Street 1:989 NATHANIEL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-3233
Practice Address - Country:US
Practice Address - Phone:216-413-8496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400171331002376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide