Provider Demographics
NPI:1063250322
Name:LIQUIGAN, LORELEI MARQUEZ (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LORELEI
Middle Name:MARQUEZ
Last Name:LIQUIGAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-1486
Mailing Address - Country:US
Mailing Address - Phone:281-898-3436
Mailing Address - Fax:
Practice Address - Street 1:805 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-1486
Practice Address - Country:US
Practice Address - Phone:281-898-3436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1025945363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner