Provider Demographics
NPI:1164990255
Name:CANTY, SIRITA LASHAWN (LPN)
Entity Type:Individual
Prefix:
First Name:SIRITA
Middle Name:LASHAWN
Last Name:CANTY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1596 RULANE DR
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1364
Mailing Address - Country:US
Mailing Address - Phone:313-737-1500
Mailing Address - Fax:
Practice Address - Street 1:1596 RULANE DR
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1364
Practice Address - Country:US
Practice Address - Phone:313-737-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703108891164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse