Healthcare Provider Details

I. General information

NPI: 1831617182
Provider Name (Legal Business Name): THOMAS LYNN QUIGG RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 09/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 N CENTRAL AVE
PHOENIX AZ
85012-1817
US

IV. Provider business mailing address

1605 W WILLETTA ST
PHOENIX AZ
85007-1819
US

V. Phone/Fax

Practice location:
  • Phone: 602-764-1100
  • Fax:
Mailing address:
  • Phone: 480-250-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number159101
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: