Provider Demographics
NPI:1659668002
Name:AKINS, QUDTIA L (RN)
Entity Type:Individual
Prefix:MS
First Name:QUDTIA
Middle Name:L
Last Name:AKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:136 HENDERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13209-1856
Mailing Address - Country:US
Mailing Address - Phone:315-303-5452
Mailing Address - Fax:
Practice Address - Street 1:136 HENDERSON BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13209-1856
Practice Address - Country:US
Practice Address - Phone:315-303-5452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267829164W00000X
NY749031163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No164W00000XNursing Service ProvidersLicensed Practical Nurse