Provider Demographics
NPI:1780424895
Name:WILSON-MITCHELL, LASHONDA (LPN)
Entity type:Individual
Prefix:
First Name:LASHONDA
Middle Name:
Last Name:WILSON-MITCHELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9664 FORD AVE UNIT 374
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-8915
Mailing Address - Country:US
Mailing Address - Phone:254-768-1486
Mailing Address - Fax:
Practice Address - Street 1:600 COMMERCIAL CT STE A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3671
Practice Address - Country:US
Practice Address - Phone:912-244-8352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN097574164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse