Provider Demographics
NPI:1902445356
Name:ANDERSON, QUINTINA ETASHA
Entity Type:Individual
Prefix:
First Name:QUINTINA
Middle Name:ETASHA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16207 N MIST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-5331
Mailing Address - Country:US
Mailing Address - Phone:832-893-3658
Mailing Address - Fax:
Practice Address - Street 1:14222 WUNDERLICH DR APT 904
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-3443
Practice Address - Country:US
Practice Address - Phone:832-893-3658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide