Provider Demographics
NPI:1740476530
Name:LASANE, TOSHIKA RENA
Entity type:Individual
Prefix:MS
First Name:TOSHIKA
Middle Name:RENA
Last Name:LASANE
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 1:1134 OGDEN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-1277
Mailing Address - Country:US
Mailing Address - Phone:336-339-1180
Mailing Address - Fax:
Practice Address - Street 1:1134 OGDEN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-1277
Practice Address - Country:US
Practice Address - Phone:336-339-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29830284347C00000X
NC252453376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No347C00000XTransportation ServicesPrivate Vehicle