Provider Demographics
NPI:1154364362
Name:QUINN, MARIBETH (CNM)
Entity type:Individual
Prefix:
First Name:MARIBETH
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NE A ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1842
Mailing Address - Country:US
Mailing Address - Phone:541-325-5001
Mailing Address - Fax:541-475-0132
Practice Address - Street 1:500 NE A ST STE 102
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1842
Practice Address - Country:US
Practice Address - Phone:541-475-4456
Practice Address - Fax:541-475-0132
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH033440-23-01367A00000X
OR251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010209Medicaid
11456705OtherCAQH
OR30010209Medicaid
NH30010209Medicaid