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1811682842
LAQUAN SUPERVILLE
NEW YORK, NY
NPI
1811682842
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: NY 350969)
Enumeration Date
2023-04-06
Last Update Date
2023-05-20
Business Address
LAQUAN SUPERVILLE
335 LENOX AVE
NEW YORK, NY 10027-3703
Phone number: 718-450-4907
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Mailing Address
LAQUAN SUPERVILLE
12911 JAMAICA AVE APT 4N
RICHMOND HILL, NY 11418-2664
Phone number: 718-450-4907
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