Provider Demographics
NPI:1295062065
Name:MYLES, LAQUITA D (RN)
Entity type:Individual
Prefix:
First Name:LAQUITA
Middle Name:D
Last Name:MYLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12023 VALLEY OAK ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3268
Mailing Address - Country:US
Mailing Address - Phone:704-929-1890
Mailing Address - Fax:
Practice Address - Street 1:12023 VALLEY OAK ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3268
Practice Address - Country:US
Practice Address - Phone:980-689-1913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8951163WS0200X
OH147604164W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program