Provider Demographics
NPI:1427538008
Name:HENDREE, LAQUETTA YVETTE (CNA, MA)
Entity Type:Individual
Prefix:MS
First Name:LAQUETTA
Middle Name:YVETTE
Last Name:HENDREE
Suffix:
Gender:F
Credentials:CNA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 MANGUM RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-5811
Mailing Address - Country:US
Mailing Address - Phone:901-281-3444
Mailing Address - Fax:
Practice Address - Street 1:2260 MANGUM RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-5811
Practice Address - Country:US
Practice Address - Phone:901-281-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174200000X, 253Z00000X, 372600000X, 374T00000X, 376K00000X, 374U00000X
TN00168002376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No174200000XOther Service ProvidersMeals
No253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No376K00000XNursing Service Related ProvidersNurse's Aide