Provider Demographics
NPI:1295418333
Name:CHISOLM, LAWANDA D
Entity type:Individual
Prefix:
First Name:LAWANDA
Middle Name:D
Last Name:CHISOLM
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 1:3016 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4172
Mailing Address - Country:US
Mailing Address - Phone:330-786-5552
Mailing Address - Fax:
Practice Address - Street 1:3016 2ND ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4172
Practice Address - Country:US
Practice Address - Phone:330-786-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide