Provider Demographics
NPI:1295943157
Name:CUNDIFF, LAKISHA R (LPN, RN)
Entity type:Individual
Prefix:MISS
First Name:LAKISHA
Middle Name:R
Last Name:CUNDIFF
Suffix:
Gender:F
Credentials:LPN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 ZIRCON ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-1761
Mailing Address - Country:US
Mailing Address - Phone:330-305-1489
Mailing Address - Fax:
Practice Address - Street 1:2536 ZIRCON ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721-1761
Practice Address - Country:US
Practice Address - Phone:330-305-1489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.116588164W00000X
OH424251163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse