Provider Demographics
NPI:1972900660
Name:SHARP, QUANISHA JEWEL (LPN)
Entity type:Individual
Prefix:MRS
First Name:QUANISHA
Middle Name:JEWEL
Last Name:SHARP
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:QUANISHA
Other - Middle Name:J
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STNA
Mailing Address - Street 1:4471 GRANADA BLVD APT 119
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-4860
Mailing Address - Country:US
Mailing Address - Phone:216-778-0050
Mailing Address - Fax:
Practice Address - Street 1:115 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3212
Practice Address - Country:US
Practice Address - Phone:216-778-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH164536164W00000X
OH400780600708376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0111235Medicaid