Provider Demographics
NPI:1538437728
Name:QUASTAD, REVADEAN J (MSN, NP-C, APNP)
Entity type:Individual
Prefix:
First Name:REVADEAN
Middle Name:J
Last Name:QUASTAD
Suffix:
Gender:F
Credentials:MSN, NP-C, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 S STATE ST STE 900
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4478
Mailing Address - Country:US
Mailing Address - Phone:072-384-9495
Mailing Address - Fax:
Practice Address - Street 1:717 S STATE ST STE 900
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031
Practice Address - Country:US
Practice Address - Phone:072-384-9495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4555-33363LF0000X
MN6831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily