Provider Demographics
NPI:1164138574
Name:BOATWRIGHT, LUCKIDA QUIOCHO
Entity Type:Individual
Prefix:MRS
First Name:LUCKIDA
Middle Name:QUIOCHO
Last Name:BOATWRIGHT
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 1:1500 E TROPICANA AVE STE 155
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6516
Mailing Address - Country:US
Mailing Address - Phone:702-450-1704
Mailing Address - Fax:702-650-0201
Practice Address - Street 1:1500 E TROPICANA AVE STE 155
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6516
Practice Address - Country:US
Practice Address - Phone:702-450-1704
Practice Address - Fax:702-650-0201
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant