Provider Demographics
NPI:1205102837
Name:KORNEGAY, LASHARA MARIE (LPN)
Entity type:Individual
Prefix:MS
First Name:LASHARA
Middle Name:MARIE
Last Name:KORNEGAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 RILEY AVE
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471
Mailing Address - Country:US
Mailing Address - Phone:330-518-8465
Mailing Address - Fax:330-755-1916
Practice Address - Street 1:3926 RILEY AVE
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-1828
Practice Address - Country:US
Practice Address - Phone:330-518-8465
Practice Address - Fax:330-755-1916
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400931810609376K00000X
OH148642164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide