Healthcare Provider Details

I. General information

NPI: 1619783958
Provider Name (Legal Business Name): QUINSIA KWEH JICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/25/2024
Certification Date: 12/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 DANNET PL
UPPER MARLBORO MD
20774-5701
US

IV. Provider business mailing address

1011 DANNET PL
UPPER MARLBORO MD
20774-5701
US

V. Phone/Fax

Practice location:
  • Phone: 240-583-9722
  • Fax:
Mailing address:
  • Phone: 240-583-9722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: