Provider Demographics
NPI:1760723241
Name:MATTHEWS, QUINISHA
Entity Type:Individual
Prefix:
First Name:QUINISHA
Middle Name:
Last Name:MATTHEWS
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 1:1217 ALAN LANE
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-0000
Mailing Address - Country:US
Mailing Address - Phone:405-573-6402
Mailing Address - Fax:405-573-3939
Practice Address - Street 1:1217 ALAN LANE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-0000
Practice Address - Country:US
Practice Address - Phone:405-573-6402
Practice Address - Fax:405-573-3939
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13385171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator