Provider Demographics
NPI:1619415668
Name:LOYD, LAQUELL
Entity Type:Individual
Prefix:
First Name:LAQUELL
Middle Name:
Last Name:LOYD
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 1:3917 AIRPORT HWY
Mailing Address - Street 2:APT. 21
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-7194
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3917 AIRPORT HWY
Practice Address - Street 2:APT.21
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7194
Practice Address - Country:US
Practice Address - Phone:419-870-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0185368Medicaid