Provider Demographics
NPI:1306690995
Name:VASQUEZ, DENISE (RN, CLC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 ATWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-4717
Mailing Address - Country:US
Mailing Address - Phone:859-351-1284
Mailing Address - Fax:
Practice Address - Street 1:124 S KEENELAND DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3279
Practice Address - Country:US
Practice Address - Phone:812-240-8797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY323118163WL0100X
KY1157757163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant