Provider Demographics
NPI:1619443868
Name:QUINTANA, GLADYS (LVN)
Entity Type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12949 EASTBROOK DR APT 353
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-5537
Mailing Address - Country:US
Mailing Address - Phone:256-706-1192
Mailing Address - Fax:
Practice Address - Street 1:12949 EASTBROOK DR APT 353
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-5537
Practice Address - Country:US
Practice Address - Phone:256-706-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342834164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse