MEDICARE: LAQUANDA RENEE RICHARDSON BS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1770924995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAQUANDA RENEE RICHARDSON BS

Provider Business Mailing Address
First Line	:	3405 S CHICKASAW TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32829-8627
Country	:	US
Telephone Number	:	407-494-1673
Fax Number	:

Provider Business Practice Location Address
First Line	:	3405 S CHICKASAW TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32829-8627
Country	:	US
Telephone Number	:	407-494-1673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2013
Last Update Date	:	11/05/2013

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