Provider Demographics
NPI:1154616720
Name:GADDIS, QUINNLON HOMER SR (RN)
Entity type:Individual
Prefix:MR
First Name:QUINNLON
Middle Name:HOMER
Last Name:GADDIS
Suffix:SR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1261
Mailing Address - Country:US
Mailing Address - Phone:440-533-5930
Mailing Address - Fax:
Practice Address - Street 1:1446 BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1261
Practice Address - Country:US
Practice Address - Phone:440-533-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH367320163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse