Provider Demographics
NPI:1659636181
Name:HALL, LAKESHA QUIANA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LAKESHA
Middle Name:QUIANA
Last Name:HALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:LAKESHA
Other - Middle Name:QUIANA
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPM
Mailing Address - Street 1:928 BROWN STREET
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:928 BROWN STREET
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3758
Practice Address - Country:US
Practice Address - Phone:414-517-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI309925-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse