Provider Demographics
NPI:1215404389
Name:QUINN, LAURA GAIL
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:GAIL
Last Name:QUINN
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 1:1605 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3850
Mailing Address - Country:US
Mailing Address - Phone:580-215-3116
Mailing Address - Fax:
Practice Address - Street 1:1605 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3850
Practice Address - Country:US
Practice Address - Phone:580-215-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator