Provider Demographics
NPI:1306699459
Name:COLEMAN, LAQUISHA MONAY
Entity type:Individual
Prefix:
First Name:LAQUISHA
Middle Name:MONAY
Last Name:COLEMAN
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 1:4319 N 76TH ST STE 5A
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2056
Mailing Address - Country:US
Mailing Address - Phone:414-813-1823
Mailing Address - Fax:
Practice Address - Street 1:8652 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-4221
Practice Address - Country:US
Practice Address - Phone:414-458-5077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health