Basic Information
| Provider Information | |||||||||
| NPI: | 1558864066 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FELIPE | ||||||||
| FirstName: | LAQUANDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FELIPE | ||||||||
| OtherFirstName: | LAQUANDA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LPN | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 233 LINDA VISTA AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH HALEDON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 075082705 | ||||||||
| CountryCode: | US | ||||||||
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| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20 OLD TURNPIKE RD | ||||||||
| Address2: | |||||||||
| City: | NANUET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109542532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456240260 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2018 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 2824481 | NY | N | Nursing Service Providers | Licensed Practical Nurse | 164W00000X | 282448-1 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.