Provider Demographics
NPI:1285413419
Name:LAWANI, INNOCENT
Entity type:Individual
Prefix:MRS
First Name:INNOCENT
Middle Name:
Last Name:LAWANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 CHALFIELD CT
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-5426
Mailing Address - Country:US
Mailing Address - Phone:614-549-1346
Mailing Address - Fax:
Practice Address - Street 1:2003 CHALFIELD CT
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-5426
Practice Address - Country:US
Practice Address - Phone:614-549-1346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver