Healthcare Provider Details

I. General information

NPI: 1477056372
Provider Name (Legal Business Name): QUANEAKA CHINTELL REED RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 CHERAW ST.
BENNETTSVILLE SC
29512
US

IV. Provider business mailing address

1035 CHERAW ST. P.O. BOX 918
BENNETTSVILLE SC
29512
US

V. Phone/Fax

Practice location:
  • Phone: 843-454-0841
  • Fax: 843-454-0635
Mailing address:
  • Phone: 843-454-0841
  • Fax: 843-454-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number205774
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: