Provider Demographics
NPI:1679811707
Name:QUINN, CHARLENE ANNE (LPN)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:ANNE
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 1:12746 VINCENT DR
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:OH
Mailing Address - Zip Code:44255-9309
Mailing Address - Country:US
Mailing Address - Phone:330-562-4774
Mailing Address - Fax:
Practice Address - Street 1:12746 VINCENT DR
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:OH
Practice Address - Zip Code:44255-9309
Practice Address - Country:US
Practice Address - Phone:330-562-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN065557164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse