MEDICARE: LAQUITA M FRANKLIN CMAA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1760269682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAQUITA M FRANKLIN CMAA

Provider Business Mailing Address
First Line	:	4418 N 57TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-5608
Country	:	US
Telephone Number	:	262-215-3859
Fax Number	:

Provider Business Practice Location Address
First Line	:	4418 N 57TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-5608
Country	:	US
Telephone Number	:	262-215-3859
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2023
Last Update Date	:	09/13/2023

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