Healthcare Provider Details

I. General information

NPI: 1104718568
Provider Name (Legal Business Name): LAQUETTA WOODS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 IVY LOOP
PHENIX CITY AL
36867-7114
US

IV. Provider business mailing address

26 IVY LOOP
PHENIX CITY AL
36867-7114
US

V. Phone/Fax

Practice location:
  • Phone: 334-650-8565
  • Fax:
Mailing address:
  • Phone: 334-650-8565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-187095
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1-187095
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-187095
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: