Individual
LAQUANZA A JETER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3600 WILKINSON BLVD, CHARLOTTE, NC 28208-5539
(704) 617-4050
(704) 733-9299
Mailing address
4117 WELLING AVE, CHARLOTTE, NC 28208-2114
(704) 712-4096
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
172A00000X
Driver
—
NC
251G00000X
Community Based Hospice Care Agency
—
NC
Other
Enumeration date
08/01/2024
Last updated
08/01/2024
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