Healthcare Provider Details

I. General information

NPI: 1417051756
Provider Name (Legal Business Name): POONAM K QUICK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 10TH ST W ST. JOSEPH'S HOSPITAL
SAINT PAUL MN
55102-1062
US

IV. Provider business mailing address

45 10TH ST W ST. JOSEPH'S HOSPITAL
SAINT PAUL MN
55102-1062
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-3382
  • Fax:
Mailing address:
  • Phone: 651-232-3382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR1354137
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: