Healthcare Provider Details

I. General information

NPI: 1184217036
Provider Name (Legal Business Name): LAQUITA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 SANTA ROSALIA DR
NORTH LAS VEGAS NV
89031-1010
US

IV. Provider business mailing address

1517 SANTA ROSALIA DR
NORTH LAS VEGAS NV
89031-1010
US

V. Phone/Fax

Practice location:
  • Phone: 702-929-3297
  • Fax:
Mailing address:
  • Phone: 702-929-3297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number1306384219
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: