Healthcare Provider Details

I. General information

NPI: 1689949810
Provider Name (Legal Business Name): QUINTA OKALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5395 AUTUMN OAK DR
MIDDLETOWN OH
45044-5091
US

IV. Provider business mailing address

5395 AUTUMN OAK DR
MIDDLETOWN OH
45044-5091
US

V. Phone/Fax

Practice location:
  • Phone: 301-760-9380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number144466
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: