Provider Demographics
NPI:1427307586
Name:NTEMGWA, QUINTA (LPN)
Entity type:Individual
Prefix:
First Name:QUINTA
Middle Name:
Last Name:NTEMGWA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 ORCHARD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-7334
Mailing Address - Country:US
Mailing Address - Phone:614-209-5259
Mailing Address - Fax:
Practice Address - Street 1:3536 ORCHARD LAKE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-7334
Practice Address - Country:US
Practice Address - Phone:614-209-5259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.142210-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse