Provider Demographics
NPI:1760743637
Name:MCFADDEN, LAQUONDA (LPN)
Entity Type:Individual
Prefix:
First Name:LAQUONDA
Middle Name:
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 SHELTER ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-3751
Mailing Address - Country:US
Mailing Address - Phone:585-413-3952
Mailing Address - Fax:
Practice Address - Street 1:89 SHELTER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3751
Practice Address - Country:US
Practice Address - Phone:585-413-3952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309356164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse