Healthcare Provider Details

I. General information

NPI: 1316356579
Provider Name (Legal Business Name): CHRISTINA ROSE QUICK DNP, CPNP-AC/PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA ROSE GOODING DNP, CPNP-AC/PC

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST SUITE E352
KALAMAZOO MI
49007-5341
US

IV. Provider business mailing address

601 JOHN ST SUITE E352
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-8986
  • Fax: 269-341-6236
Mailing address:
  • Phone: 269-341-8986
  • Fax: 269-341-6236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704316542
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: