Provider Demographics
NPI:1063858785
Name:ALINA QUY, LLC
Entity Type:Organization
Organization Name:ALINA QUY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SOISANGVANE
Authorized Official - Middle Name:ALINA
Authorized Official - Last Name:QUY
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:405-213-9853
Mailing Address - Street 1:1204 NW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73170-1477
Mailing Address - Country:US
Mailing Address - Phone:405-213-9853
Mailing Address - Fax:405-759-2738
Practice Address - Street 1:5500 NW EXPRESSWAY
Practice Address - Street 2:SUITE A
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73132-5219
Practice Address - Country:US
Practice Address - Phone:405-213-9853
Practice Address - Fax:405-759-2738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK96349363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty