Provider Demographics
NPI:1770097610
Name:VESSEL, LEQUATTA C
Entity type:Individual
Prefix:
First Name:LEQUATTA
Middle Name:C
Last Name:VESSEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEQUATTA
Other - Middle Name:
Other - Last Name:CUSHENBERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:333 E VERNA ST
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4621
Mailing Address - Country:US
Mailing Address - Phone:225-253-4889
Mailing Address - Fax:
Practice Address - Street 1:333 E VERNA ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4621
Practice Address - Country:US
Practice Address - Phone:225-253-4889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1366981557Medicaid