Provider Demographics
NPI:1740491554
Name:LAMAR, WENDA MICHELLE (LPN)
Entity type:Individual
Prefix:MISS
First Name:WENDA
Middle Name:MICHELLE
Last Name:LAMAR
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 1:17206 DEFOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2516
Mailing Address - Country:US
Mailing Address - Phone:216-205-8472
Mailing Address - Fax:
Practice Address - Street 1:17206 DEFOREST AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2516
Practice Address - Country:US
Practice Address - Phone:216-205-8472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.126145 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2734867Medicaid