Provider Demographics
NPI:1508147968
Name:CAMPBELL, LASHANDA P (LPN)
Entity Type:Individual
Prefix:MISS
First Name:LASHANDA
Middle Name:P
Last Name:CAMPBELL
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 1:4401 QUEENS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-3229
Mailing Address - Country:US
Mailing Address - Phone:937-520-0364
Mailing Address - Fax:937-275-9254
Practice Address - Street 1:4401 QUEENS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-3229
Practice Address - Country:US
Practice Address - Phone:937-520-0364
Practice Address - Fax:937-275-9254
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.143310-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse