Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 126800000X | Dental Assistant | ||
Y | 126800000X | Dental Assistant | 63869 | CA |
NPI | 1346610458 |
---|---|
Provider Name | Lashawn Nichols |
First Address | Long Beach, CA 90802-1231 |
Second Address | Long Beach, CA 90815-2850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2015 |
Last Update Date | 03/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1346610458 | DENTICAL (01) | CA |