Provider Demographics
NPI:1447886684
Name:QUINTANA, ELISA (LVN)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 NORTHWESTERN DR APT 5105
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8031
Mailing Address - Country:US
Mailing Address - Phone:915-275-6533
Mailing Address - Fax:
Practice Address - Street 1:1325 NORTHWESTERN DR APT 5105
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-8031
Practice Address - Country:US
Practice Address - Phone:915-275-6533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLPN-21920164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse