Healthcare Provider Details

I. General information

NPI: 1720998909
Provider Name (Legal Business Name): QUINN BABCOCK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 W 9 MILE RD APT 428
FERNDALE MI
48220-3036
US

IV. Provider business mailing address

430 W 9 MILE RD APT 428
FERNDALE MI
48220-3036
US

V. Phone/Fax

Practice location:
  • Phone: 248-736-0556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601014318
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: