Healthcare Provider Details

I. General information

NPI: 1376520189
Provider Name (Legal Business Name): CATHERINE K QUINN MS,RD,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: CATHERINE K OLIVER MS,RD,LD

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 CHILDREN'S PL MS 90-21-342
ST LOUIS MO
63110
US

IV. Provider business mailing address

4950 CHILDREN'S PL MS 90-21-342
ST LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-4517
  • Fax: 314-362-6959
Mailing address:
  • Phone: 314-362-4517
  • Fax: 314-362-6959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2001027042
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: