Provider Demographics
NPI:1851193452
Name:FORD, LANICE MARIE
Entity type:Individual
Prefix:
First Name:LANICE
Middle Name:MARIE
Last Name:FORD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5308 WARRENSVILLE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137
Mailing Address - Country:US
Mailing Address - Phone:216-510-0739
Mailing Address - Fax:
Practice Address - Street 1:5308 WARRENSVILLE CENTER RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137
Practice Address - Country:US
Practice Address - Phone:216-510-0739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier