Provider Demographics
NPI:1437773447
Name:WATKINS, LAQUANNA
Entity Type:Individual
Prefix:
First Name:LAQUANNA
Middle Name:
Last Name:WATKINS
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 1:9 E LAWLOR ST UNIT 2E
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-1184
Mailing Address - Country:US
Mailing Address - Phone:860-994-3139
Mailing Address - Fax:
Practice Address - Street 1:9 E LAWLOR ST UNIT 2E
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-1184
Practice Address - Country:US
Practice Address - Phone:860-994-3139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider