Healthcare Provider Details

I. General information

NPI: 1124158340
Provider Name (Legal Business Name): VALERIE QUINN RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 ENCINO PL NE 28
ALBUQUERQUE NM
87102-2611
US

IV. Provider business mailing address

717 ENCINO PL NE 28
ALBUQUERQUE NM
87102-2611
US

V. Phone/Fax

Practice location:
  • Phone: 505-338-4800
  • Fax: 505-338-4808
Mailing address:
  • Phone: 505-338-4800
  • Fax: 505-338-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR29764
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: