Basic Information
| Provider Information | |||||||||
| NPI: | 1588322085 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDONALD | ||||||||
| FirstName: | LAKASHA | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1724 ROXIE AVE | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283041623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197589317 | ||||||||
| FaxNumber: | 9107785936 | ||||||||
| Practice Location | |||||||||
| Address1: | 1724 ROXIE AVE | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283041623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197589317 | ||||||||
| FaxNumber: | 9107785936 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2021 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 089668 | NC | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.