Provider Demographics
NPI:1306443130
Name:POLLOCK, LANA J
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:J
Last Name:POLLOCK
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 1:5050 S WALNUT ST LOT 6
Mailing Address - Street 2:
Mailing Address - City:SOUTH BLOOMFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43103-1079
Mailing Address - Country:US
Mailing Address - Phone:740-207-1134
Mailing Address - Fax:
Practice Address - Street 1:5050 S WALNUT ST LOT 6
Practice Address - Street 2:
Practice Address - City:SOUTH BLOOMFIELD
Practice Address - State:OH
Practice Address - Zip Code:43103-1079
Practice Address - Country:US
Practice Address - Phone:740-207-1134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide