Provider Demographics
NPI:1295272847
Name:MCINNIS, LAHNIAH
Entity type:Individual
Prefix:
First Name:LAHNIAH
Middle Name:
Last Name:MCINNIS
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 1:8011 N POINT BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3879
Mailing Address - Country:US
Mailing Address - Phone:336-602-6680
Mailing Address - Fax:
Practice Address - Street 1:8011 N POINT BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3879
Practice Address - Country:US
Practice Address - Phone:336-602-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4870253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care