Provider Demographics
NPI:1518622174
Name:NEWSOM, LAQUASHA L
Entity Type:Individual
Prefix:
First Name:LAQUASHA
Middle Name:L
Last Name:NEWSOM
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 1:4898 CHESTERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-6433
Mailing Address - Country:US
Mailing Address - Phone:901-314-9428
Mailing Address - Fax:
Practice Address - Street 1:3592 KNIGHT ARNOLD RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-2709
Practice Address - Country:US
Practice Address - Phone:901-314-9428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ036792Medicaid