Provider Demographics
NPI:1871087320
Name:BERQUEST, ELIZABETH LOUISE (LPN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LOUISE
Last Name:BERQUEST
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LOUISE
Other - Last Name:STENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:511 CHOKER ST SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1532
Mailing Address - Country:US
Mailing Address - Phone:360-970-3181
Mailing Address - Fax:
Practice Address - Street 1:4012 WIGGINS RD SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-4372
Practice Address - Country:US
Practice Address - Phone:360-491-1036
Practice Address - Fax:360-491-1416
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60835975164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse