Provider Demographics
NPI:1801378799
Name:MUHAMMAD, LAKISA QUINETTE (CPM, LM)
Entity Type:Individual
Prefix:MRS
First Name:LAKISA
Middle Name:QUINETTE
Last Name:MUHAMMAD
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17180 N MORENO PL
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-1879
Mailing Address - Country:US
Mailing Address - Phone:602-429-9501
Mailing Address - Fax:
Practice Address - Street 1:17180 N MORENO PL
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-1879
Practice Address - Country:US
Practice Address - Phone:602-429-9501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
AZLM234176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty