Healthcare Provider Details

I. General information

NPI: 1780160135
Provider Name (Legal Business Name): QUINN DEMOTT HAUSER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 E MAIN ST
DURHAM NC
27701-3720
US

IV. Provider business mailing address

111 APPLECROSS CT
DURHAM NC
27713-9333
US

V. Phone/Fax

Practice location:
  • Phone: 919-560-7603
  • Fax: 919-560-7874
Mailing address:
  • Phone: 703-887-7414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5010750
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5010750
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: