Provider Demographics
NPI:1871020164
Name:QWEPUE, ISAAC IVERSON (NURSING)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:IVERSON
Last Name:QWEPUE
Suffix:
Gender:M
Credentials:NURSING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 JORDAN DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2004
Mailing Address - Country:US
Mailing Address - Phone:215-431-5197
Mailing Address - Fax:302-674-5259
Practice Address - Street 1:229 JORDAN DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2004
Practice Address - Country:US
Practice Address - Phone:215-431-5197
Practice Address - Fax:302-674-5259
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2468103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE$$$$$$$$$Medicaid