Healthcare Provider Details

I. General information

NPI: 1417502634
Provider Name (Legal Business Name): LAQUANNA J GARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2652 NONA RD
COLUMBUS OH
43207-2716
US

IV. Provider business mailing address

2652 NONA RD
COLUMBUS OH
43207-2716
US

V. Phone/Fax

Practice location:
  • Phone: 614-702-5080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: