Provider Demographics
NPI:1154971778
Name:BARNES, LAQUITA (CERTHAIR LOSS SPEC)
Entity type:Individual
Prefix:
First Name:LAQUITA
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:CERTHAIR LOSS SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6252 BISHOPS POND LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-4934
Mailing Address - Country:US
Mailing Address - Phone:317-200-0165
Mailing Address - Fax:
Practice Address - Street 1:8319 MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3635
Practice Address - Country:US
Practice Address - Phone:317-200-0165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management