Provider Demographics
NPI:1053125559
Name:THOMPSON, LASHANNA ANTOINETTE
Entity type:Individual
Prefix:
First Name:LASHANNA
Middle Name:ANTOINETTE
Last Name:THOMPSON
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 1:9664 GULL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-6892
Mailing Address - Country:US
Mailing Address - Phone:317-250-9829
Mailing Address - Fax:
Practice Address - Street 1:9664 GULL LAKE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-6892
Practice Address - Country:US
Practice Address - Phone:317-250-9829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN250185741253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care