Provider Demographics
NPI:1639326598
Name:MITCHELL, QIANA ROCHELLIQUE (LPN)
Entity Type:Individual
Prefix:MS
First Name:QIANA
Middle Name:ROCHELLIQUE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 JAMES BUCHANAN DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-3320
Mailing Address - Country:US
Mailing Address - Phone:228-861-2136
Mailing Address - Fax:
Practice Address - Street 1:1717 JAMES BUCHANAN DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-3320
Practice Address - Country:US
Practice Address - Phone:228-861-2136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP323180164W00000X
LA05447164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse