Provider Demographics
NPI:1831618883
Name:QUARLES, JERIEL MARSENA (LPN)
Entity type:Individual
Prefix:MRS
First Name:JERIEL
Middle Name:MARSENA
Last Name:QUARLES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:JERIEL
Other - Middle Name:MARSENA
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1617 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6724
Mailing Address - Country:US
Mailing Address - Phone:815-730-4200
Mailing Address - Fax:815-730-4224
Practice Address - Street 1:1617 W JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435
Practice Address - Country:US
Practice Address - Phone:815-730-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043-055935164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse