Provider Demographics
NPI:1184187833
Name:HAGGINS, LAQUINA S (CNA)
Entity Type:Individual
Prefix:
First Name:LAQUINA
Middle Name:S
Last Name:HAGGINS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 DOVER AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2845
Mailing Address - Country:US
Mailing Address - Phone:330-937-8079
Mailing Address - Fax:
Practice Address - Street 1:869 DOVER AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2845
Practice Address - Country:US
Practice Address - Phone:330-937-8079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0246557Medicaid