Provider Demographics
NPI:1962074252
Name:LITTERAL, QUINTEN
Entity type:Individual
Prefix:
First Name:QUINTEN
Middle Name:
Last Name:LITTERAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9765 W HASKETT LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1605
Mailing Address - Country:US
Mailing Address - Phone:937-623-1813
Mailing Address - Fax:
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2643
Practice Address - Country:US
Practice Address - Phone:937-208-6173
Practice Address - Fax:937-208-3843
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.403093163WS0200X
OH136750367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WS0200XNursing Service ProvidersRegistered NurseSchool