Provider Demographics
NPI:1124827878
Name:BLACKMON, QUINTONNA (CMA, CNA)
Entity type:Individual
Prefix:
First Name:QUINTONNA
Middle Name:
Last Name:BLACKMON
Suffix:
Gender:
Credentials:CMA, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1897
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-1897
Mailing Address - Country:US
Mailing Address - Phone:410-782-5577
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1897
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-1897
Practice Address - Country:US
Practice Address - Phone:410-782-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC60045543376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide