Provider Demographics
NPI:1285039024
Name:LASKLEY, CHARMA (LPN)
Entity Type:Individual
Prefix:
First Name:CHARMA
Middle Name:
Last Name:LASKLEY
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 1:3206 UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63107-2626
Mailing Address - Country:US
Mailing Address - Phone:314-435-0842
Mailing Address - Fax:
Practice Address - Street 1:3206 UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63107-2626
Practice Address - Country:US
Practice Address - Phone:314-435-0842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000158985164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse