Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 16144-NP | OH |
NPI | 1619388329 |
---|---|
Provider Name | Andrea Nicole Quick |
First Address | Moraine, OH 45439-1924 |
Second Address | Dayton, OH 45406-1813 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2014 |
Last Update Date | 01/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0136162 | (05) | OH |