Provider Demographics
NPI:1164973954
Name:UMEMBA, LAQUISHA RENEE (MPH, BSN, RN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:LAQUISHA
Middle Name:RENEE
Last Name:UMEMBA
Suffix:
Gender:F
Credentials:MPH, BSN, RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6725 DERBY DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-3954
Mailing Address - Country:US
Mailing Address - Phone:501-912-7452
Mailing Address - Fax:
Practice Address - Street 1:6725 DERBY DOWNS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78747-3954
Practice Address - Country:US
Practice Address - Phone:501-912-7452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX896671163WC1500X, 163WC1600X, 251J00000X, 163WD0400X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No174H00000XOther Service ProvidersHealth Educator
No251J00000XAgenciesNursing Care