Healthcare Provider Details

I. General information

NPI: 1619388329
Provider Name (Legal Business Name): ANDREA NICOLE QUICK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 PHILADELPHIA DR
DAYTON OH
45406-1813
US

IV. Provider business mailing address

3170 KETTERING BLVD BUILDING B, 3RD FLOOR
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-734-3516
  • Fax:
Mailing address:
  • Phone: 937-991-3188
  • Fax: 937-223-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number16144-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: