Provider Demographics
NPI:1073861548
Name:WARREN, QUANTANIECE SHANTE
Entity Type:Individual
Prefix:
First Name:QUANTANIECE
Middle Name:SHANTE
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:QUANTANIECE
Other - Middle Name:SHANTE
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:STATE LICENSE
Mailing Address - Street 1:1341 E 143RD ST # UP
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-2539
Mailing Address - Country:US
Mailing Address - Phone:216-322-3126
Mailing Address - Fax:
Practice Address - Street 1:1341 E 143RD ST # UP
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-2539
Practice Address - Country:US
Practice Address - Phone:216-322-3126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401385720512376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH40385720512OtherSTATE TESTED NURSING ASISSTANT