1457744336 NPI number — MRS. LAJUANA MCQUEEN WILLIS R.N.

Table of content: MRS. LAJUANA MCQUEEN WILLIS R.N. (NPI 1457744336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457744336 NPI number — MRS. LAJUANA MCQUEEN WILLIS R.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIS
Provider First Name:
LAJUANA
Provider Middle Name:
MCQUEEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCQUEEN
Provider Other First Name:
LAJUANA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.N.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457744336
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10710 CHARTER DR
Provider Second Line Business Mailing Address:
#200
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21044-3128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-884-8000
Provider Business Mailing Address Fax Number:
410-997-6019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10710 CHARTER DR
Provider Second Line Business Practice Location Address:
#200
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044-3128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-884-8000
Provider Business Practice Location Address Fax Number:
410-997-6019
Provider Enumeration Date:
03/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WW0101X , with the licence number:  R171824 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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