Provider Demographics
NPI:1942575436
Name:WYNN, LAQUINDA NICOLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LAQUINDA
Middle Name:NICOLE
Last Name:WYNN
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 1:1668 CREST HILL AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-1134
Mailing Address - Country:US
Mailing Address - Phone:513-371-0825
Mailing Address - Fax:
Practice Address - Street 1:1668 CREST HILL AVE
Practice Address - Street 2:APT 3
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-1134
Practice Address - Country:US
Practice Address - Phone:513-371-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN147765164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse