Provider Demographics
NPI:1558136325
Name:CONNER, LASHAWN A
Entity Type:Individual
Prefix:
First Name:LASHAWN
Middle Name:A
Last Name:CONNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5779 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-3068
Mailing Address - Country:US
Mailing Address - Phone:216-314-7592
Mailing Address - Fax:
Practice Address - Street 1:5779 COLONIAL BLVD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-3068
Practice Address - Country:US
Practice Address - Phone:216-314-7592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator