Provider Demographics
NPI:1134701964
Name:QIU, QIONG
Entity Type:Individual
Prefix:
First Name:QIONG
Middle Name:
Last Name:QIU
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 1:1021 DARRINGTON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8158
Mailing Address - Country:US
Mailing Address - Phone:919-852-3999
Mailing Address - Fax:919-378-9114
Practice Address - Street 1:1021 DARRINGTON DR STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8158
Practice Address - Country:US
Practice Address - Phone:919-852-3999
Practice Address - Fax:919-378-9114
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014330363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care