MEDICARE: QUENESHA FOOTE RN

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	163W00000X	Registered Nurse	521218	OH

General Provider Information

NPI Number	:	1770346058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUENESHA FOOTE RN

Provider Business Mailing Address
First Line	:	6324 MAPLEWOOD RD APT 102
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-1842
Country	:	US
Telephone Number	:	216-256-1399
Fax Number	:

Provider Business Practice Location Address
First Line	:	6324 MAPLEWOOD RD APT 102
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-1842
Country	:	US
Telephone Number	:	216-256-1399
Fax Number	:

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

Provider Enumeration Date	:	01/31/2024
Last Update Date	:	01/31/2024

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