Provider Demographics
NPI:1003373572
Name:SEALS, QUATANYA
Entity Type:Individual
Prefix:
First Name:QUATANYA
Middle Name:
Last Name:SEALS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:QUATANYA
Other - Middle Name:
Other - Last Name:SEALS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:9931 S CRANDON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-5243
Mailing Address - Country:US
Mailing Address - Phone:773-892-5566
Mailing Address - Fax:
Practice Address - Street 1:9931 S CRANDON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-5243
Practice Address - Country:US
Practice Address - Phone:773-892-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041424259163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041424259OtherILLINOIS NURSING BOARD