Healthcare Provider Details

I. General information

NPI: 1346431228
Provider Name (Legal Business Name): VERONICA LYNNE QUINLAN LMT 5680
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

5706 TANGLEWOOD PL
LAS CRUCES NM
88012-8348
US

IV. Provider business mailing address

5706 TANGLEWOOD PL
LAS CRUCES NM
88012-8348
US

V. Phone/Fax

Practice location:
  • Phone: 505-649-4241
  • Fax:
Mailing address:
  • Phone: 505-649-4241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5680
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: