Provider Demographics
NPI:1679292122
Name:JOB, DELANA LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:DELANA
Middle Name:LYNN
Last Name:JOB
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DELANA
Other - Middle Name:LYNN
Other - Last Name:QUINONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:311 WHITE INGRAM PKWY # 301
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0969
Mailing Address - Country:US
Mailing Address - Phone:678-363-7447
Mailing Address - Fax:
Practice Address - Street 1:311 WHITE INGRAM PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-0969
Practice Address - Country:US
Practice Address - Phone:678-363-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN082688164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse