Provider Demographics
NPI:1477012193
Name:CHARLES, LASHONDA (LPN)
Entity type:Individual
Prefix:
First Name:LASHONDA
Middle Name:
Last Name:CHARLES
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 1:10543 S CRATER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23805-7333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10543 S CRATER RD
Practice Address - Street 2:
Practice Address - City:SOUTH PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23805-7333
Practice Address - Country:US
Practice Address - Phone:804-431-5585
Practice Address - Fax:804-431-5820
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002092107164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse