Provider Demographics
NPI:1932748696
Name:LAGUERRE, MYRLANDE
Entity Type:Individual
Prefix:
First Name:MYRLANDE
Middle Name:
Last Name:LAGUERRE
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 1:5315 THRASHER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-3566
Mailing Address - Country:US
Mailing Address - Phone:317-793-7391
Mailing Address - Fax:
Practice Address - Street 1:10921 REED HARTMAN HWY STE 325
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2849
Practice Address - Country:US
Practice Address - Phone:317-793-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-29
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH410467164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse