Provider Demographics
NPI:1356476204
Name:TAYLOR, QUENETTA JEAN (LPN PROVIDER 2663685)
Entity Type:Individual
Prefix:MS
First Name:QUENETTA
Middle Name:JEAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPN PROVIDER 2663685
Other - Prefix:MS
Other - First Name:QUENETTA
Other - Middle Name:JEAN
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 UNION HILL CIR
Mailing Address - Street 2:APT D
Mailing Address - City:W CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449
Mailing Address - Country:US
Mailing Address - Phone:937-439-4989
Mailing Address - Fax:
Practice Address - Street 1:400 UNION HILL CIR
Practice Address - Street 2:APT D
Practice Address - City:W CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-3726
Practice Address - Country:US
Practice Address - Phone:937-439-4989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN118889164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse