Provider Demographics
NPI:1801443817
Name:SANDERS, LAQUANDA P (LPN)
Entity type:Individual
Prefix:
First Name:LAQUANDA
Middle Name:P
Last Name:SANDERS
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 1:415 FIRE WILLOW ST NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8179
Mailing Address - Country:US
Mailing Address - Phone:512-992-3192
Mailing Address - Fax:
Practice Address - Street 1:2401 BRISTOL CT SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6003
Practice Address - Country:US
Practice Address - Phone:360-751-2124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60889663164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27461483OtherDL