Provider Demographics
NPI:1538441522
Name:QUINLAN, KIMBERLY ANNE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:QUINLAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1024
Mailing Address - Country:US
Mailing Address - Phone:607-661-2974
Mailing Address - Fax:
Practice Address - Street 1:134 SENECA ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1324
Practice Address - Country:US
Practice Address - Phone:607-324-3710
Practice Address - Fax:607-324-3710
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331424-1163W00000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163W00000XNursing Service ProvidersRegistered Nurse