Provider Demographics
NPI:1497578967
Name:CAPAWANA, AMALIA QUINTANILLA
Entity type:Individual
Prefix:
First Name:AMALIA
Middle Name:QUINTANILLA
Last Name:CAPAWANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMALIA
Other - Middle Name:QUINTANILLA
Other - Last Name:CAPAWANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN CASE MANAGER
Mailing Address - Street 1:100 BREWSTER BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547-2575
Mailing Address - Country:US
Mailing Address - Phone:910-450-3171
Mailing Address - Fax:910-450-4783
Practice Address - Street 1:NAVAL HOSPITAL ANNEX NH200
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547
Practice Address - Country:US
Practice Address - Phone:910-450-3171
Practice Address - Fax:910-450-4783
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC219900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse