Provider Demographics
NPI:1487813143
Name:LASKO, AMANDA K
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:LASKO
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 1:27834 SANDERS LN
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-1768
Mailing Address - Country:US
Mailing Address - Phone:440-777-0331
Mailing Address - Fax:
Practice Address - Street 1:27834 SANDERS LN
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-1768
Practice Address - Country:US
Practice Address - Phone:440-777-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2459852Medicaid