Provider Demographics
NPI:1215502679
Name:AHERN, QUINN
Entity type:Individual
Prefix:
First Name:QUINN
Middle Name:
Last Name:AHERN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3390 COACHMAN RD STE 214
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-3478
Mailing Address - Country:US
Mailing Address - Phone:651-452-4220
Mailing Address - Fax:651-452-3829
Practice Address - Street 1:3390 COACHMAN RD STE 214
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-3478
Practice Address - Country:US
Practice Address - Phone:651-452-4220
Practice Address - Fax:651-452-3829
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist