Healthcare Provider Details

I. General information

NPI: 1700130036
Provider Name (Legal Business Name): LAKEYSHIA FIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAACH, 121ST CSH/USAMEDDAC-K UNIT # 15244
APO AP
96205
US

IV. Provider business mailing address

A CO CSH UNIT 15244 BOX 425
APO AP
96205
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-1751
  • Fax:
Mailing address:
  • Phone: 315-737-1751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number0001207424
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: