Provider Demographics
NPI:1912549437
Name:UPSHAW, QWINTORIA Q (NP)
Entity Type:Individual
Prefix:MRS
First Name:QWINTORIA
Middle Name:Q
Last Name:UPSHAW
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:720 ESKENAZI AVE
Mailing Address - Street 2:FIFTH THIRD BANK BLDG, 5TH FL
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5166
Mailing Address - Country:US
Mailing Address - Phone:317-880-4121
Mailing Address - Fax:317-880-0343
Practice Address - Street 1:5515 W 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2919
Practice Address - Country:US
Practice Address - Phone:317-880-3838
Practice Address - Fax:317-880-0448
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28160353A163W00000X
IN71009549A363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology