Provider Demographics
NPI:1790852432
Name:QUAIL, ANNETTE E (LIC AC)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:E
Last Name:QUAIL
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HIGHLAND AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1668
Mailing Address - Country:US
Mailing Address - Phone:978-590-6459
Mailing Address - Fax:
Practice Address - Street 1:145 HIGHLAND AVE
Practice Address - Street 2:APT. 1
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1668
Practice Address - Country:US
Practice Address - Phone:978-590-6459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230177171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist