Provider Demographics
NPI:1235640624
Name:WILLIAMS, LAQUETTA SHERRI (LVN)
Entity Type:Individual
Prefix:
First Name:LAQUETTA
Middle Name:SHERRI
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14460 DALTON CT
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-3211
Mailing Address - Country:US
Mailing Address - Phone:760-810-6817
Mailing Address - Fax:
Practice Address - Street 1:14460 DALTON CT
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-3211
Practice Address - Country:US
Practice Address - Phone:760-810-6817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247815164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse