Provider Demographics
NPI:1356974430
Name:POWELL, LAKENDRIA MONIQUE
Entity type:Individual
Prefix:
First Name:LAKENDRIA
Middle Name:MONIQUE
Last Name:POWELL
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 1:26241 LAKE SHORE BLVD APT 1463
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1145
Mailing Address - Country:US
Mailing Address - Phone:216-394-3851
Mailing Address - Fax:
Practice Address - Street 1:1008 E 66TH PL
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-1606
Practice Address - Country:US
Practice Address - Phone:216-269-7706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide