Provider Demographics
NPI:1194037655
Name:WESLEY, LARUNDA LASHAN
Entity Type:Individual
Prefix:
First Name:LARUNDA
Middle Name:LASHAN
Last Name:WESLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LARUNDA
Other - Middle Name:LASHAN
Other - Last Name:WESLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSING ASSISTANT
Mailing Address - Street 1:250 E 257TH ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1048
Mailing Address - Country:US
Mailing Address - Phone:216-289-0814
Mailing Address - Fax:216-289-0814
Practice Address - Street 1:250 E 257TH ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-1048
Practice Address - Country:US
Practice Address - Phone:216-289-0814
Practice Address - Fax:216-289-0814
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH375836040896376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide