Healthcare Provider Details

I. General information

NPI: 1972417467
Provider Name (Legal Business Name): LAQUANDA HATCH LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E MONUMENT AVE STE 403
DAYTON OH
45402-1634
US

IV. Provider business mailing address

140 E MONUMENT AVE STE 403
DAYTON OH
45402-1634
US

V. Phone/Fax

Practice location:
  • Phone: 937-831-4194
  • Fax:
Mailing address:
  • Phone: 937-831-4194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.198318
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: