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General NPI Number Information
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NPI Number | 1063858785
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Entity Type | Organization
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Legal Business Name | ALINA QUY, LLC
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Dates
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Enumeration Date | 05/21/2013
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Last Update Date | 05/21/2013
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Provider Practice Location Address
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Address Line | 5500 NW EXPRESSWAY SUITE A
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City | WARR ACRES
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State | OK
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Zip | 73132-5219
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Country | US
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Telephone | 405-213-9853
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Fax | 405-759-2738
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Provider Business Mailing Address
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Address Line | 1204 NW 15TH ST
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City | MOORE
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State | OK
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Zip | 73170-1477
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Country | US
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Telephone | 405-213-9853
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Fax | 405-759-2738
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Authorized Official
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Title or Position | OWNER
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Name | MS. SOISANGVANE ALINA QUY
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Credential | CNP
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Telephone | 405-213-9853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 96349
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License Number State | OK
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