1588690903 NPI number — PATRICIA L LAQUA MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588690903 NPI number — PATRICIA L LAQUA MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LAQUA

Provider First Name:

PATRICIA

Provider Middle Name:

L

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1588690903

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/10/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 2010

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FARGO

Provider Business Mailing Address State Name:

ND

Provider Business Mailing Address Postal Code:

58122-2484

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

2400 32ND AVE S

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

FARGO

Provider Business Practice Location Address State Name:

ND

Provider Business Practice Location Address Postal Code:

58103-5800

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

701-234-2000

Provider Business Practice Location Address Fax Number:

701-234-8803

Provider Enumeration Date:

06/25/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  9807 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 27243 . This is a "NDBS #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 759S5LA . This is a "MNBS #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 0124374 . This is a "MEDICA #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 181850 . This is a "UCARE #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 0124375 . This is a "MEDICA #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 816183600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 0124373 . This is a "MEDICA #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 13584 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
• Identifier: HP69894 . This is a "HEALTHPARTNERS #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 2444457 . This is a "AMERICA'S PPO-ARAZ #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 648N0LA . This is a "MNBS #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: DA9011045621 . This is a "PREFERRED ONE #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".