Provider Demographics
NPI:1528773157
Name:NASUKU, QUEEN
Entity type:Individual
Prefix:
First Name:QUEEN
Middle Name:
Last Name:NASUKU
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 1:4525 DRAYTON CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-1901
Mailing Address - Country:US
Mailing Address - Phone:937-286-3037
Mailing Address - Fax:
Practice Address - Street 1:4525 DRAYTON CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-1901
Practice Address - Country:US
Practice Address - Phone:937-286-3037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide