Provider Demographics
NPI:1891272860
Name:DAVIS, QUINETTA CHANTEL (RN)
Entity Type:Individual
Prefix:
First Name:QUINETTA
Middle Name:CHANTEL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 PAYDAY LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-7426
Mailing Address - Country:US
Mailing Address - Phone:614-290-3521
Mailing Address - Fax:
Practice Address - Street 1:3221 PAYDAY LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-7426
Practice Address - Country:US
Practice Address - Phone:614-290-3521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.420911163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health