Provider Demographics
NPI:1700406188
Name:WARD, LAKEISHA NAMONE (CNA)
Entity Type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:NAMONE
Last Name:WARD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 OLD STATE RD APT 100B
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3227
Mailing Address - Country:US
Mailing Address - Phone:843-751-5128
Mailing Address - Fax:
Practice Address - Street 1:601 OLD STATE RD APT 100B
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3227
Practice Address - Country:US
Practice Address - Phone:843-751-5128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-25
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC118176374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide