MEDICARE: BRIAN ANTHONY QUINN RN,NP

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	163WP0200X	Pediatric Registered Nurse	367611	CA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NP5698	CA

General Provider Information

NPI Number	:	1841368230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN ANTHONY QUINN RN,NP

Provider Business Mailing Address
First Line	:	480 TESCONI CIR STE B
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4691
Country	:	US
Telephone Number	:	707-206-7268
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 TESCONI CIR STE B
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4691
Country	:	US
Telephone Number	:	707-206-7268
Fax Number	:

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	11/18/2021

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