Provider Demographics
NPI:1285717371
Name:QUINTAVALLE, JOYCE MACHIN (CRNP-P)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:MACHIN
Last Name:QUINTAVALLE
Suffix:
Gender:F
Credentials:CRNP-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17326 BUSHLAND RD
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21120-9476
Mailing Address - Country:US
Mailing Address - Phone:410-343-1503
Mailing Address - Fax:410-343-1562
Practice Address - Street 1:501 STEMMERS RUN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-3333
Practice Address - Country:US
Practice Address - Phone:410-574-4397
Practice Address - Fax:410-574-4397
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO41468363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics