Provider Demographics
NPI:1881044725
Name:WHITE, LAKEDRA
Entity Type:Individual
Prefix:
First Name:LAKEDRA
Middle Name:
Last Name:WHITE
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 1:3540 N HUALAPAI WAY
Mailing Address - Street 2:2023
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-4062
Mailing Address - Country:US
Mailing Address - Phone:318-514-9543
Mailing Address - Fax:
Practice Address - Street 1:8021 BROKEN SPUR LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-4511
Practice Address - Country:US
Practice Address - Phone:318-514-9543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner