Provider Demographics
NPI:1265919138
Name:SMITH, QEUNNA DONTE (RN,FNP)
Entity type:Individual
Prefix:
First Name:QEUNNA
Middle Name:DONTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 INDIAN RIVER RD STE A
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-3148
Mailing Address - Country:US
Mailing Address - Phone:577-271-1286
Mailing Address - Fax:757-226-9173
Practice Address - Street 1:4351 INDIAN RIVER RD STE A
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23325-3148
Practice Address - Country:US
Practice Address - Phone:757-271-1286
Practice Address - Fax:757-226-9173
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001251637363LS0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool