Provider Demographics
NPI:1063912046
Name:WILLIAMS, LAQUANIA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LAQUANIA
Middle Name:
Last Name:WILLIAMS
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 1:470 COUNTY ROAD 471
Mailing Address - Street 2:
Mailing Address - City:VARDAMAN
Mailing Address - State:MS
Mailing Address - Zip Code:38878-9770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:470 COUNTY ROAD 471
Practice Address - Street 2:
Practice Address - City:VARDAMAN
Practice Address - State:MS
Practice Address - Zip Code:38878-9770
Practice Address - Country:US
Practice Address - Phone:662-628-0621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901863363LP2300X
CA95008190363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care