Provider Demographics
NPI:1467297135
Name:QUENTRILL, TY DANIELLE (LPN)
Entity type:Individual
Prefix:
First Name:TY
Middle Name:DANIELLE
Last Name:QUENTRILL
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 1:300B PRESTIGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8419
Mailing Address - Country:US
Mailing Address - Phone:304-202-3864
Mailing Address - Fax:304-757-0522
Practice Address - Street 1:300B PRESTIGE PARK DR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8419
Practice Address - Country:US
Practice Address - Phone:304-202-3864
Practice Address - Fax:304-757-0522
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39087164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse