Provider Demographics
NPI:1902587348
Name:ASLAM, LARA
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:ASLAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6157 S CHANTICLEER DR
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1303
Mailing Address - Country:US
Mailing Address - Phone:419-345-0055
Mailing Address - Fax:
Practice Address - Street 1:6157 S CHANTICLEER DR
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1303
Practice Address - Country:US
Practice Address - Phone:419-345-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.392817163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine