Provider Demographics
NPI:1285354464
Name:ASHLEY, LAKIRAH
Entity type:Individual
Prefix:
First Name:LAKIRAH
Middle Name:
Last Name:ASHLEY
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 1:4814 PEBBLE CRK N APT 8
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-4891
Mailing Address - Country:US
Mailing Address - Phone:248-989-5552
Mailing Address - Fax:
Practice Address - Street 1:4814 PEBBLE CRK N APT 8
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-4891
Practice Address - Country:US
Practice Address - Phone:248-989-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI000011137376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI882452812OtherBENEVOLENT HOME GROUP LLC