1689632754 NPI number — MRS. LAQUINA SHATEL WASHINGTON LPN

Table of content: MRS. LAQUINA SHATEL WASHINGTON LPN (NPI 1689632754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689632754 NPI number — MRS. LAQUINA SHATEL WASHINGTON LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASHINGTON
Provider First Name:
LAQUINA
Provider Middle Name:
SHATEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPENCER
Provider Other First Name:
LAQUINA
Provider Other Middle Name:
SHATEL
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689632754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5471 DR MARTIN LUTHER KING DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63112-4265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-367-5820
Provider Business Mailing Address Fax Number:
314-367-7010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5471 DR MARTIN LUTHER KING DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63112-4265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-367-5820
Provider Business Practice Location Address Fax Number:
314-367-7010
Provider Enumeration Date:
05/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  2004012469 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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