Provider Demographics
NPI:1336838580
Name:SLOAN, ICIS LAQUANA
Entity Type:Individual
Prefix:
First Name:ICIS
Middle Name:LAQUANA
Last Name:SLOAN
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 1:1308 GALLAUDET ST NE APT 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1646
Mailing Address - Country:US
Mailing Address - Phone:202-209-3919
Mailing Address - Fax:
Practice Address - Street 1:1308 GALLAUDET ST NE APT 202
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1646
Practice Address - Country:US
Practice Address - Phone:202-209-3919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide