Provider Demographics
NPI:1922765817
Name:BOGAN, LASHAWN DENISE
Entity Type:Individual
Prefix:MS
First Name:LASHAWN
Middle Name:DENISE
Last Name:BOGAN
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 1:544 S HAWKINS AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1255
Mailing Address - Country:US
Mailing Address - Phone:330-957-8555
Mailing Address - Fax:
Practice Address - Street 1:544 S HAWKINS AVE APT 3
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1255
Practice Address - Country:US
Practice Address - Phone:330-957-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker