Provider Demographics
NPI:1538729207
Name:LEQUEUX, LISA ELAINE
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ELAINE
Last Name:LEQUEUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3859 MAPLETON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-9509
Mailing Address - Country:US
Mailing Address - Phone:716-807-5258
Mailing Address - Fax:
Practice Address - Street 1:3859 MAPLETON RD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-9509
Practice Address - Country:US
Practice Address - Phone:716-807-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-15
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist