Provider Demographics
NPI:1366920928
Name:LARKINS, QUANTA
Entity type:Individual
Prefix:
First Name:QUANTA
Middle Name:
Last Name:LARKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17132 KINGSBROOKE CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3729
Mailing Address - Country:US
Mailing Address - Phone:313-422-5679
Mailing Address - Fax:586-203-8385
Practice Address - Street 1:17132 KINGSBROOKE CIR APT 101
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3729
Practice Address - Country:US
Practice Address - Phone:313-422-5679
Practice Address - Fax:586-203-8385
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-04
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8507115Medicaid