Provider Demographics
NPI:1346544970
Name:CLARK, LASHAWN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LASHAWN
Middle Name:
Last Name:CLARK
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 1:2689 WESTWOOD NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-6108
Mailing Address - Country:US
Mailing Address - Phone:513-324-8412
Mailing Address - Fax:
Practice Address - Street 1:2689 WESTWOOD NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6108
Practice Address - Country:US
Practice Address - Phone:513-324-8412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN117273164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse