MEDICARE: KAITLYN DAWN QUINN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704315600	MI

General Provider Information

NPI Number	:	1043172968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN DAWN QUINN

Provider Business Mailing Address
First Line	:	8449 WILLIAMSTOWN DR
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-2656
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8449 WILLIAMSTOWN DR
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-2656
Country	:	US
Telephone Number	:	586-864-6873
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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Directions to “ KAITLYN DAWN QUINN ” Practice Location

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