Provider Demographics
NPI:1659623262
Name:QUINTEL, LACEY
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:QUINTEL
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 1:1784 GOLFVIEW DR APT 4
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-9614
Mailing Address - Country:US
Mailing Address - Phone:989-272-7214
Mailing Address - Fax:
Practice Address - Street 1:2723 STATE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3754
Practice Address - Country:US
Practice Address - Phone:989-272-7214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker