Provider Demographics
NPI:1710567938
Name:WARE, QUNTAVIA (CNA CAREGIVER)
Entity Type:Individual
Prefix:MS
First Name:QUNTAVIA
Middle Name:
Last Name:WARE
Suffix:
Gender:F
Credentials:CNA CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 DELTA ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36605-2212
Mailing Address - Country:US
Mailing Address - Phone:251-620-9044
Mailing Address - Fax:
Practice Address - Street 1:1904 DELTA ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36605-2212
Practice Address - Country:US
Practice Address - Phone:251-620-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty