MEDICARE: QUANTANIECE SHANTE WARREN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	401385720512	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40385720512	OTHER	OH	STATE TESTED NURSING ASISSTANT

General Provider Information

NPI Number	:	1073861548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUANTANIECE SHANTE WARREN

Provider Business Mailing Address
First Line	:	1341 E 143RD ST # UP
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-2539
Country	:	US
Telephone Number	:	216-322-3126
Fax Number	:

Provider Business Practice Location Address
First Line	:	1341 E 143RD ST # UP
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-2539
Country	:	US
Telephone Number	:	216-322-3126
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	08/15/2012

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Directions to “ QUANTANIECE SHANTE WARREN ” Practice Location

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