Provider Demographics
NPI:1922480748
Name:QUINTANA, EVANGELIA
Entity Type:Individual
Prefix:
First Name:EVANGELIA
Middle Name:
Last Name:QUINTANA
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 1:1033 STOWELL DR
Mailing Address - Street 2:APT 1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-1855
Mailing Address - Country:US
Mailing Address - Phone:585-727-3540
Mailing Address - Fax:
Practice Address - Street 1:1033 STOWELL DR
Practice Address - Street 2:APT 1
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-1855
Practice Address - Country:US
Practice Address - Phone:585-727-3540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY685086163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY685086Medicaid