Healthcare Provider Details

I. General information

NPI: 1063555985
Provider Name (Legal Business Name): LYDIA QUINN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 E 13TH AVE
ANCHORAGE AK
99501-4739
US

IV. Provider business mailing address

1142 E 13TH AVE
ANCHORAGE AK
99501-4739
US

V. Phone/Fax

Practice location:
  • Phone: 907-229-2857
  • Fax:
Mailing address:
  • Phone: 907-229-2857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number100521
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number100521
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number100521
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number100521
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: