Provider Demographics
NPI:1558409870
Name:DEGRATE, LASHAWN DANIELLE
Entity Type:Individual
Prefix:
First Name:LASHAWN
Middle Name:DANIELLE
Last Name:DEGRATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4702 SW SLAVIN RD
Mailing Address - Street 2:APT. 22
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2873
Mailing Address - Country:US
Mailing Address - Phone:503-490-2482
Mailing Address - Fax:
Practice Address - Street 1:7621 N PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-5953
Practice Address - Country:US
Practice Address - Phone:503-240-7599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion