Provider Demographics
NPI:1346946191
Name:ALEXANDER-ELLIS, LAQUETTA
Entity Type:Individual
Prefix:MRS
First Name:LAQUETTA
Middle Name:
Last Name:ALEXANDER-ELLIS
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 1:255 ORANGE ST STE 206
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210-2404
Mailing Address - Country:US
Mailing Address - Phone:518-448-8077
Mailing Address - Fax:
Practice Address - Street 1:255 ORANGE ST STE 206
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12210-2404
Practice Address - Country:US
Practice Address - Phone:518-448-8077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY88-379294OtherN/A