Provider Demographics
NPI:1083019368
Name:BIGBEE, CEQUEILA VONTAE (CERTIFIED NURSING)
Entity Type:Individual
Prefix:
First Name:CEQUEILA
Middle Name:VONTAE
Last Name:BIGBEE
Suffix:
Gender:F
Credentials:CERTIFIED NURSING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 N LEHMBERG RD APT E36
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-5565
Mailing Address - Country:US
Mailing Address - Phone:720-506-0627
Mailing Address - Fax:
Practice Address - Street 1:186 N LEHMBERG RD APT E36
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5565
Practice Address - Country:US
Practice Address - Phone:720-506-0627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA061882376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide