Individual
LAWAN SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
48 METRIC DR, TALLMADGE, OH 44278-2337
(330) 615-7634
Mailing address
48 METRIC DR, TALLMADGE, OH 44278-2337
(330) 615-7634
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0094288
—
OH
Enumeration date
06/01/2015
Last updated
06/01/2015
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