Healthcare Provider Details

I. General information

NPI: 1942264544
Provider Name (Legal Business Name): EMMELINE P QUIASON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17221 E 23RD ST S #206
INDEPENDENCE MO
64057-1803
US

IV. Provider business mailing address

17221 E 23RD ST S #206
INDEPENDENCE MO
64057-1803
US

V. Phone/Fax

Practice location:
  • Phone: 816-373-1911
  • Fax:
Mailing address:
  • Phone: 816-373-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR3A14
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: