Provider Demographics
NPI:1336774231
Name:WILSON, QUINTENDA LVETT (NURSE)
Entity Type:Individual
Prefix:
First Name:QUINTENDA
Middle Name:LVETT
Last Name:WILSON
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4038 STONEHENGE DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3420
Mailing Address - Country:US
Mailing Address - Phone:502-475-6231
Mailing Address - Fax:
Practice Address - Street 1:4038 STONEHENGE DR
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-3420
Practice Address - Country:US
Practice Address - Phone:502-475-6231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-102215363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health