MEDICARE: MRS. YING QU

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	363LF0000X	Family Nurse Practitioner	APN0000020435	TN
2	363LF0000X	Family Nurse Practitioner	5014538	NC
3	363LF0000X	Family Nurse Practitioner	NP95003632	CA
4	363LF0000X	Family Nurse Practitioner	26363	SC

General Provider Information

NPI Number	:	1194198234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YING QU

Provider Business Mailing Address
First Line	:	PO BOX 470408
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28247-0408
Country	:	US
Telephone Number	:	704-375-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 RED VENTURES DR STE 130
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29707-2516
Country	:	US
Telephone Number	:	704-375-0100
Fax Number	:

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

Provider Enumeration Date	:	11/11/2015
Last Update Date	:	10/08/2025

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Directions to “ MRS. YING QU ” Practice Location

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