Provider Demographics
NPI:1255571717
Name:WASHINGTON, QIANA MARIE
Entity type:Individual
Prefix:
First Name:QIANA
Middle Name:MARIE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:QIANA
Other - Middle Name:MARIE
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:3707 W GOOD HOPE RD
Mailing Address - Street 2:APT # 15
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2385
Mailing Address - Country:US
Mailing Address - Phone:414-745-2377
Mailing Address - Fax:
Practice Address - Street 1:3707 W GOOD HOPE RD
Practice Address - Street 2:APT # 15
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-2385
Practice Address - Country:US
Practice Address - Phone:414-745-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI305988031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse