Provider Demographics
NPI:1588486260
Name:CAMPBELL, KA'NISHA LASHAI (LPN)
Entity type:Individual
Prefix:
First Name:KA'NISHA
Middle Name:LASHAI
Last Name:CAMPBELL
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 1:1386 VANDEMAR ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1635
Mailing Address - Country:US
Mailing Address - Phone:216-466-1255
Mailing Address - Fax:
Practice Address - Street 1:1386 VANDEMAR ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44121-1635
Practice Address - Country:US
Practice Address - Phone:216-466-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH187322164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty