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General NPI Number Information
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NPI Number | 1184492597
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Entity Type | Individual
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Provider Name | WINTANA OQUBU
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Gender | Female
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Dates
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Enumeration Date | 12/14/2023
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 17 E 8TH AVE
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City | SPOKANE
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State | WA
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Zip | 99202-1201
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Country | US
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Telephone | 509-474-5678
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Fax |
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Provider Business Mailing Address
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Address Line | 563 W 2920 S
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City | SYRACUSE
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State | UT
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Zip | 84075-9569
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Country | US
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Telephone | 916-846-8870
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 19806
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 707048
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 13153183-3101
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License Number State | UT
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