Provider Demographics
NPI:1104243302
Name:QUINONES, SANDRA L
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:L
Last Name:QUINONES
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 1:300 E. HOSPITAL ROAD
Mailing Address - Street 2:
Mailing Address - City:FT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905
Mailing Address - Country:US
Mailing Address - Phone:706-787-6945
Mailing Address - Fax:706-787-8131
Practice Address - Street 1:300 E. HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:FT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905
Practice Address - Country:US
Practice Address - Phone:706-787-6945
Practice Address - Fax:706-787-8131
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN204813163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management