1922283423 NPI number — MS. ERICA LAQUONIA SINGLETON RN

Table of content: MS. ERICA LAQUONIA SINGLETON RN (NPI 1922283423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922283423 NPI number — MS. ERICA LAQUONIA SINGLETON RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SINGLETON
Provider First Name:
ERICA
Provider Middle Name:
LAQUONIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JACKSON
Provider Other First Name:
PATRICK
Provider Other Middle Name:
JAROME
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
I
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1922283423
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2350 BLUEBIRD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38701-8127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-332-7820
Provider Business Mailing Address Fax Number:
662-332-7022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1654 HIGHWAY 1 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38701-7108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-332-7022
Provider Business Practice Location Address Fax Number:
662-332-7022
Provider Enumeration Date:
01/02/2008

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: 251C00000X , with the licence number:  07186736 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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