Provider Demographics
NPI:1417116815
Name:QUINN, ANGELA LAURA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:LAURA
Last Name:QUINN
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 1:4 WEST ALTMAN STREET
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-2407
Mailing Address - Country:US
Mailing Address - Phone:912-764-6129
Mailing Address - Fax:
Practice Address - Street 1:4 W ALTMAN ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5277
Practice Address - Country:US
Practice Address - Phone:912-764-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN075018164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse