Provider Demographics
NPI:1790362101
Name:DONALD, JOANQUIL
Entity Type:Individual
Prefix:
First Name:JOANQUIL
Middle Name:
Last Name:DONALD
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 1:2219 LIZARDI ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-3535
Mailing Address - Country:US
Mailing Address - Phone:504-333-9893
Mailing Address - Fax:
Practice Address - Street 1:2219 LIZARDI ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-3535
Practice Address - Country:US
Practice Address - Phone:504-333-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator