Provider Demographics
NPI:1528810306
Name:LASTER, MARQUITA D (LPN)
Entity type:Individual
Prefix:
First Name:MARQUITA
Middle Name:D
Last Name:LASTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 W 101ST ST APT 9
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-2645
Mailing Address - Country:US
Mailing Address - Phone:216-533-3046
Mailing Address - Fax:
Practice Address - Street 1:1442 W 101ST ST APT 9
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-2645
Practice Address - Country:US
Practice Address - Phone:216-533-3046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.170003.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse