Provider Demographics
NPI:1093249120
Name:QUARLES, TEONNA (STNA)
Entity Type:Individual
Prefix:
First Name:TEONNA
Middle Name:
Last Name:QUARLES
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11755 NORBOURNE DR APT 904
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-4421
Mailing Address - Country:US
Mailing Address - Phone:513-430-6825
Mailing Address - Fax:
Practice Address - Street 1:11755 NORBOURNE DR APT 904
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-4421
Practice Address - Country:US
Practice Address - Phone:513-430-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-15
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401684180814376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide