Provider Demographics
NPI:1770945610
Name:ROBERSON, LASHANTA (RN)
Entity type:Individual
Prefix:
First Name:LASHANTA
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 CLETUS PKWY
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2909
Mailing Address - Country:US
Mailing Address - Phone:419-905-3600
Mailing Address - Fax:
Practice Address - Street 1:2916 CLETUS PKWY
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2909
Practice Address - Country:US
Practice Address - Phone:419-905-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN255417163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse