Provider Demographics
NPI:1437653474
Name:LASHOMB, KRISTIN LEE
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEE
Last Name:LASHOMB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:LEE
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:56 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1747
Mailing Address - Country:US
Mailing Address - Phone:315-265-4065
Mailing Address - Fax:
Practice Address - Street 1:56 MARKET ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1747
Practice Address - Country:US
Practice Address - Phone:315-265-4065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294367164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse