Healthcare Provider Details

I. General information

NPI: 1700590445
Provider Name (Legal Business Name): ANTONYIA LEE QUINN RUMPH BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 ANTRIM PL
KANNAPOLIS NC
28081-0201
US

IV. Provider business mailing address

3721 ANTRIM PL
KANNAPOLIS NC
28081-0201
US

V. Phone/Fax

Practice location:
  • Phone: 336-419-6647
  • Fax:
Mailing address:
  • Phone: 336-419-6647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number29840008
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number29840008
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number29840008
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: