Provider Demographics
NPI:1447711106
Name:LAKEY, JANIQUE JADE (NA)
Entity type:Individual
Prefix:
First Name:JANIQUE
Middle Name:JADE
Last Name:LAKEY
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:POMEROY
Mailing Address - State:WA
Mailing Address - Zip Code:99347-0965
Mailing Address - Country:US
Mailing Address - Phone:509-843-7625
Mailing Address - Fax:
Practice Address - Street 1:1509 MAIN ST
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:WA
Practice Address - Zip Code:99347-9708
Practice Address - Country:US
Practice Address - Phone:509-843-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHM60732804374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide