Provider Demographics
NPI:1184197188
Name:WILLIAMS, LAQUEISHA NAQUAE
Entity Type:Individual
Prefix:
First Name:LAQUEISHA
Middle Name:NAQUAE
Last Name:WILLIAMS
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 1:3406 RIVIERA ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-7516
Mailing Address - Country:US
Mailing Address - Phone:318-423-8058
Mailing Address - Fax:
Practice Address - Street 1:3406 RIVIERA ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-7516
Practice Address - Country:US
Practice Address - Phone:318-423-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer