Healthcare Provider Details

I. General information

NPI: 1497346522
Provider Name (Legal Business Name): CAITLYN QUINN RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 5TH ST
SANTA ROSA CA
95404-4428
US

IV. Provider business mailing address

14189 ARMSTRONG WOODS RD
GUERNEVILLE CA
95446-9511
US

V. Phone/Fax

Practice location:
  • Phone: 707-696-6934
  • Fax: 707-565-4430
Mailing address:
  • Phone: 386-847-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95226091
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: