Healthcare Provider Details

I. General information

NPI: 1437020120
Provider Name (Legal Business Name): CHIQUITA LANEIL LAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 BATTLEFIELD DR
TUPELO MS
38801-3194
US

IV. Provider business mailing address

310 BATTLEFIELD DR
TUPELO MS
38801-3194
US

V. Phone/Fax

Practice location:
  • Phone: 662-422-9569
  • Fax:
Mailing address:
  • Phone: 662-422-9569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1973628
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: