Healthcare Provider Details

I. General information

NPI: 1972900660
Provider Name (Legal Business Name): QUANISHA JEWEL SHARP LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: QUANISHA J WILCOX STNA

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 03/08/2020
Certification Date: 03/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W JACKSON ST
PAINESVILLE OH
44077-3212
US

IV. Provider business mailing address

4471 GRANADA BLVD APT 119
WARRENSVILLE HEIGHTS OH
44128-4860
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-0050
  • Fax:
Mailing address:
  • Phone: 216-778-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400780600708
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number164536
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: