Provider Demographics
NPI:1588304059
Name:COLVIN, ANQUINETTE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:ANQUINETTE
Middle Name:
Last Name:COLVIN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:ANQUINETTE
Other - Middle Name:
Other - Last Name:COLVIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:16601 LUELLA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2618
Mailing Address - Country:US
Mailing Address - Phone:708-715-4586
Mailing Address - Fax:708-575-2442
Practice Address - Street 1:8543 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-4710
Practice Address - Country:US
Practice Address - Phone:708-925-4585
Practice Address - Fax:708-575-2442
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041291124163W00000X, 251E00000X
IL163W00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163W00000XNursing Service ProvidersRegistered Nurse