Individual
QUANIQUA MATUTE-ISLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
6653 EASTBRIAR DR, LITHONIA, GA 30058-8945
(470) 294-2103
Mailing address
6653 EASTBRIAR DR, LITHONIA, GA 30058-8945
(470) 294-2103
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
CN0008918328
GA
374U00000X
Home Health Aide
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Other
Enumeration date
04/15/2022
Last updated
06/06/2022
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