Provider Demographics
NPI:1477606036
Name:MCBRIDE, CHIQUANA L
Entity Type:Individual
Prefix:
First Name:CHIQUANA
Middle Name:L
Last Name:MCBRIDE
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 1:5009 BEATTIES FORD RD
Mailing Address - Street 2:107-207
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2859
Mailing Address - Country:US
Mailing Address - Phone:704-392-2505
Mailing Address - Fax:704-392-2506
Practice Address - Street 1:3410 ANN FRANKLIN CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-7643
Practice Address - Country:US
Practice Address - Phone:704-392-2505
Practice Address - Fax:704-392-2506
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3620374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide