Provider Demographics
NPI:1568208668
Name:DEAN, QIANA DENISE (RN)
Entity type:Individual
Prefix:
First Name:QIANA
Middle Name:DENISE
Last Name:DEAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:QIANA
Other - Middle Name:DENISE
Other - Last Name:MCGOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2116 HICKORYDALE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-2241
Mailing Address - Country:US
Mailing Address - Phone:937-204-7538
Mailing Address - Fax:
Practice Address - Street 1:2116 HICKORYDALE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-2241
Practice Address - Country:US
Practice Address - Phone:937-204-7538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401399163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse