Healthcare Provider Details

I. General information

NPI: 1477606036
Provider Name (Legal Business Name): CHIQUANA L MCBRIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 ANN FRANKLIN CT
CHARLOTTE NC
28216-7643
US

IV. Provider business mailing address

5009 BEATTIES FORD RD 107-207
CHARLOTTE NC
28216-2859
US

V. Phone/Fax

Practice location:
  • Phone: 704-392-2505
  • Fax: 704-392-2506
Mailing address:
  • Phone: 704-392-2505
  • Fax: 704-392-2506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHC3620
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: