Provider Demographics
NPI:1760958706
Name:LANSIQUOT, MENOVA NICOLE
Entity Type:Individual
Prefix:MRS
First Name:MENOVA
Middle Name:NICOLE
Last Name:LANSIQUOT
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 1:95 EMBER BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1107
Mailing Address - Country:US
Mailing Address - Phone:340-690-6382
Mailing Address - Fax:
Practice Address - Street 1:95 EMBER BRANCH DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-1107
Practice Address - Country:US
Practice Address - Phone:832-440-0843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX952009163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse