Provider Demographics
NPI:1982833687
Name:WASHINGTON, LERIN T (RN)
Entity Type:Individual
Prefix:MRS
First Name:LERIN
Middle Name:T
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4595 W SPRING CREEK PKWY APT 3326
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5247
Mailing Address - Country:US
Mailing Address - Phone:414-840-0778
Mailing Address - Fax:
Practice Address - Street 1:4595 W SPRING CREEK PKWY APT 3326
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5247
Practice Address - Country:US
Practice Address - Phone:414-840-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI151018163W00000X
TX833589163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38348000Medicaid