Provider Demographics
NPI:1174770044
Name:MCKITRIC, LEQUAN RAYMONE (CNA)
Entity type:Individual
Prefix:MR
First Name:LEQUAN
Middle Name:RAYMONE
Last Name:MCKITRIC
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 BOOTH AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-1646
Mailing Address - Country:US
Mailing Address - Phone:419-320-4265
Mailing Address - Fax:
Practice Address - Street 1:1542 BOOTH AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-1646
Practice Address - Country:US
Practice Address - Phone:419-320-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide