Healthcare Provider Details

I. General information

NPI: 1063230019
Provider Name (Legal Business Name): QUICK PHYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8114 SANDPIPER CIR STE 207
NOTTINGHAM MD
21236-5902
US

IV. Provider business mailing address

8114 SANDPIPER CIR STE 207
NOTTINGHAM MD
21236-5902
US

V. Phone/Fax

Practice location:
  • Phone: 443-600-8178
  • Fax: 833-973-4725
Mailing address:
  • Phone: 443-854-1553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DONTA WALTON
Title or Position: OWNER
Credential: NP
Phone: 443-600-8178