Provider Demographics
NPI:1114755303
Name:DILLARD, LAKRESHA LAVERNE
Entity type:Individual
Prefix:
First Name:LAKRESHA
Middle Name:LAVERNE
Last Name:DILLARD
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 1:18475 FAIRPORT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2632
Mailing Address - Country:US
Mailing Address - Phone:313-205-7196
Mailing Address - Fax:
Practice Address - Street 1:1390 CHALMERS ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-3602
Practice Address - Country:US
Practice Address - Phone:313-205-7196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker