Provider Demographics
NPI:1083448351
Name:QUINN, MCKENNA FAITH (PA-C)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:FAITH
Last Name:QUINN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:GWINN
Mailing Address - State:MI
Mailing Address - Zip Code:49841-9613
Mailing Address - Country:US
Mailing Address - Phone:517-213-3079
Mailing Address - Fax:
Practice Address - Street 1:111 N BIRCH ST
Practice Address - Street 2:
Practice Address - City:GWINN
Practice Address - State:MI
Practice Address - Zip Code:49841-9613
Practice Address - Country:US
Practice Address - Phone:517-213-3079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant