Provider Demographics
NPI:1982369971
Name:QUENCER, ANNA ELIZABETH (LPN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ELIZABETH
Last Name:QUENCER
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:PO BOX 593
Mailing Address - Street 2:
Mailing Address - City:CHAUMONT
Mailing Address - State:NY
Mailing Address - Zip Code:13622-0593
Mailing Address - Country:US
Mailing Address - Phone:315-783-5241
Mailing Address - Fax:
Practice Address - Street 1:11757 NYS RT 12E
Practice Address - Street 2:
Practice Address - City:CHAUMONT
Practice Address - State:NY
Practice Address - Zip Code:13622-4116
Practice Address - Country:US
Practice Address - Phone:315-783-5241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333424164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse