Provider Demographics
NPI:1447729926
Name:LAWRENCE, LA'QUDIA SANDORA (RN)
Entity type:Individual
Prefix:MS
First Name:LA'QUDIA
Middle Name:SANDORA
Last Name:LAWRENCE
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 1:54 HOMER AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2302
Mailing Address - Country:US
Mailing Address - Phone:585-953-1118
Mailing Address - Fax:
Practice Address - Street 1:1232 LATTA RD APT A
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-4040
Practice Address - Country:US
Practice Address - Phone:585-773-3482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY805931163W00000X
NY0132958164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty