Provider Demographics
NPI:1396417481
Name:QUICK, ALLYSON CHANTELL (LPN)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:CHANTELL
Last Name:QUICK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6374
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61204-6374
Mailing Address - Country:US
Mailing Address - Phone:309-912-4425
Mailing Address - Fax:
Practice Address - Street 1:1522 9TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-3432
Practice Address - Country:US
Practice Address - Phone:309-912-4425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.125779164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse