Provider Demographics
NPI:1487271623
Name:RADWAY, LASEAN DENISE (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:LASEAN
Middle Name:DENISE
Last Name:RADWAY
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12105 AUBURN SHORES CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4703
Mailing Address - Country:US
Mailing Address - Phone:240-319-0689
Mailing Address - Fax:
Practice Address - Street 1:12727 FEATHERWOOD DR STE 103
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4907
Practice Address - Country:US
Practice Address - Phone:713-476-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-04
Last Update Date:2020-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145858363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health