Provider Demographics
NPI:1235523846
Name:WILLIAMS, QUANTINA SHERVON (STNA)
Entity Type:Individual
Prefix:
First Name:QUANTINA
Middle Name:SHERVON
Last Name:WILLIAMS
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 1:12909 REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-2961
Mailing Address - Country:US
Mailing Address - Phone:216-466-3428
Mailing Address - Fax:
Practice Address - Street 1:12909 REVERE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-2961
Practice Address - Country:US
Practice Address - Phone:216-466-3428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH.401726780215376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide