Healthcare Provider Details

I. General information

NPI: 1942532353
Provider Name (Legal Business Name): SUZANNE QUILICI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E LONG ST
CARSON CITY NV
89706-3129
US

IV. Provider business mailing address

212 W ANN ST
CARSON CITY NV
89703-3901
US

V. Phone/Fax

Practice location:
  • Phone: 775-887-2190
  • Fax:
Mailing address:
  • Phone: 775-885-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number09778
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number00070
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: