Provider Demographics
NPI:1922795798
Name:HANCOCK, LACONDA
Entity Type:Individual
Prefix:
First Name:LACONDA
Middle Name:
Last Name:HANCOCK
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 1:12759 FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4582
Mailing Address - Country:US
Mailing Address - Phone:832-434-9515
Mailing Address - Fax:
Practice Address - Street 1:1302 MOSSRIDGE DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-4125
Practice Address - Country:US
Practice Address - Phone:832-434-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver