Provider Demographics
NPI:1760154884
Name:LEE, LAQUANDA MONIQUE
Entity Type:Individual
Prefix:MS
First Name:LAQUANDA
Middle Name:MONIQUE
Last Name:LEE
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 1:3526 SAGE DALE CT
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-7974
Mailing Address - Country:US
Mailing Address - Phone:980-307-1378
Mailing Address - Fax:
Practice Address - Street 1:3526 SAGE DALE CT
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-7974
Practice Address - Country:US
Practice Address - Phone:980-307-1378
Practice Address - Fax:980-307-1378
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty