Provider Demographics
NPI:1578355871
Name:MAXIE, LASHONDAR K
Entity type:Individual
Prefix:MS
First Name:LASHONDAR
Middle Name:K
Last Name:MAXIE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LASHONDAR
Other - Middle Name:KAY
Other - Last Name:MAXIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LASHONDAR SMALL
Mailing Address - Street 1:11380 S VIRGINIA ST APT 1322
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-8261
Mailing Address - Country:US
Mailing Address - Phone:909-746-6596
Mailing Address - Fax:
Practice Address - Street 1:11380 S VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-9035
Practice Address - Country:US
Practice Address - Phone:909-746-6596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV820016164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse