Healthcare Provider Details

I. General information

NPI: 1700115235
Provider Name (Legal Business Name): JANIS MARIE QUINN RN, MSN, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANIS MARIE RUSIN RN, MSN, CPNP-AC

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E. CHICAGO AVE
CHICAGO IL
60611-2605
US

IV. Provider business mailing address

225 E. CHICAGO AVE BOX 98
CHICAGO IL
60611-2605
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-3700
  • Fax: 312-227-9603
Mailing address:
  • Phone: 312-227-3700
  • Fax: 312-227-9603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number209.007901
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: