Provider Demographics
NPI:1811537608
Name:XUE, QI SI (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:QI SI
Middle Name:
Last Name:XUE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17031 RUE VALENTINE
Mailing Address - Street 2:
Mailing Address - City:PIERREFONDS
Mailing Address - State:QC
Mailing Address - Zip Code:H9J 3N1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:133 PARK ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1244
Practice Address - Country:US
Practice Address - Phone:151-848-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY345359OtherNEW YORK STATE EDUCATION DEPARTMENT