Provider Demographics
NPI:1639940315
Name:LAROCQUE, CHANI LYNN (LPS)
Entity Type:Individual
Prefix:
First Name:CHANI
Middle Name:LYNN
Last Name:LAROCQUE
Suffix:
Gender:F
Credentials:LPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 874
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0874
Mailing Address - Country:US
Mailing Address - Phone:701-550-6357
Mailing Address - Fax:
Practice Address - Street 1:340 RED ROAD DR
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-0874
Practice Address - Country:US
Practice Address - Phone:701-550-6357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND437175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist