MEDICARE: MRS. G. KATHLEEN QUIMBY RN

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	163W00000X	Registered Nurse	RN00047638	WA

General Provider Information

NPI Number	:	1457604449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. G. KATHLEEN QUIMBY RN

Provider Business Mailing Address
First Line	:	2601 SW KENYON ST.
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-8126
Country	:	US
Telephone Number	:	206-252-9007
Fax Number	:	206-743-3117

Provider Business Practice Location Address
First Line	:	2601 SW KENYON ST.
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-8126
Country	:	US
Telephone Number	:	206-252-9007
Fax Number	:	206-743-3117

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

Provider Enumeration Date	:	10/16/2012
Last Update Date	:	10/16/2012

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