Provider Demographics
NPI:1902299191
Name:QUAYE, LAURA KAI (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KAI
Last Name:QUAYE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4990 ARLINGTON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-2757
Mailing Address - Country:US
Mailing Address - Phone:951-785-9011
Mailing Address - Fax:
Practice Address - Street 1:4990 ARLINGTON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-2757
Practice Address - Country:US
Practice Address - Phone:951-785-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002064363L00000X
CA829473163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse