Provider Demographics
NPI:1992694228
Name:MATTHEWS, QIANA TENE (LPN)
Entity type:Individual
Prefix:
First Name:QIANA
Middle Name:TENE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 12TH ST # 400712TH
Mailing Address - Street 2:
Mailing Address - City:ECORSE
Mailing Address - State:MI
Mailing Address - Zip Code:48229-1305
Mailing Address - Country:US
Mailing Address - Phone:313-624-7182
Mailing Address - Fax:
Practice Address - Street 1:4007 12TH ST
Practice Address - Street 2:
Practice Address - City:ECORSE
Practice Address - State:MI
Practice Address - Zip Code:48229-1305
Practice Address - Country:US
Practice Address - Phone:313-624-7182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703121451164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse