Provider Demographics
NPI:1144937293
Name:MARYLAND, LAQUANA CHERIE (RN)
Entity type:Individual
Prefix:
First Name:LAQUANA
Middle Name:CHERIE
Last Name:MARYLAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9656 CYPRESS GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8356
Mailing Address - Country:US
Mailing Address - Phone:916-710-5757
Mailing Address - Fax:
Practice Address - Street 1:9656 CYPRESS GARDEN LN
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-8356
Practice Address - Country:US
Practice Address - Phone:916-710-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA827334163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA827334OtherBOARD OF REGISTERED NURSING