Provider Demographics
NPI:1134823263
Name:GUILLEBEAUX-QUARLES, EDWINA YVONNW (RN)
Entity type:Individual
Prefix:MRS
First Name:EDWINA
Middle Name:YVONNW
Last Name:GUILLEBEAUX-QUARLES
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 1:713 BROOKS RD
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2754
Mailing Address - Country:US
Mailing Address - Phone:864-593-3369
Mailing Address - Fax:
Practice Address - Street 1:503 S MAIN ST STE 6025
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2204
Practice Address - Country:US
Practice Address - Phone:864-593-3369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC243122163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse