Provider Demographics
NPI:1578376794
Name:FLAX, LASONDA
Entity type:Individual
Prefix:
First Name:LASONDA
Middle Name:
Last Name:FLAX
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 1:216 JESSAMINE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39203-1541
Mailing Address - Country:US
Mailing Address - Phone:769-366-9256
Mailing Address - Fax:
Practice Address - Street 1:3904 OBANNON DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-5346
Practice Address - Country:US
Practice Address - Phone:769-366-9256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility