Provider Demographics
NPI:1497511679
Name:GALES, LAQUANDRA
Entity Type:Individual
Prefix:
First Name:LAQUANDRA
Middle Name:
Last Name:GALES
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 1:914 CORVUS CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2695
Mailing Address - Country:US
Mailing Address - Phone:704-369-1571
Mailing Address - Fax:
Practice Address - Street 1:914 CORVUS CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-2695
Practice Address - Country:US
Practice Address - Phone:704-369-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula