Provider Demographics
NPI:1083217459
Name:MATHEW, QUENTRA
Entity Type:Individual
Prefix:
First Name:QUENTRA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 37TH AVE S APT T3
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-6205
Mailing Address - Country:US
Mailing Address - Phone:206-771-5213
Mailing Address - Fax:
Practice Address - Street 1:5900 37TH AVE S APT T3
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-6205
Practice Address - Country:US
Practice Address - Phone:206-771-5213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator