Provider Demographics
NPI:1275291122
Name:PHIPPS, LASHONADA SHERRELL
Entity Type:Individual
Prefix:
First Name:LASHONADA
Middle Name:SHERRELL
Last Name:PHIPPS
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 1:556 23RD ST E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-2359
Mailing Address - Country:US
Mailing Address - Phone:701-561-3020
Mailing Address - Fax:
Practice Address - Street 1:556 23RD ST E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-2359
Practice Address - Country:US
Practice Address - Phone:701-561-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant