Healthcare Provider Details

I. General information

NPI: 1861005274
Provider Name (Legal Business Name): SADIE QUINN ENKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SADIE QUINN HUDSON

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 03/20/2024
Certification Date: 03/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 OXFORD STREET
CHULA VISTA CA
91911
US

IV. Provider business mailing address

690 OXFORD STREET
CHULA VISTA CA
91911
US

V. Phone/Fax

Practice location:
  • Phone: 619-869-1905
  • Fax:
Mailing address:
  • Phone: 619-869-1905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95230369
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4705927
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: