Healthcare Provider Details

I. General information

NPI: 1073730073
Provider Name (Legal Business Name): COLLEEN M QUINLAN WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 JEFFERSON AVE
TOLEDO OH
43604-5838
US

IV. Provider business mailing address

1301 JEFFERSON AVE
TOLEDO OH
43604-5838
US

V. Phone/Fax

Practice location:
  • Phone: 419-255-1115
  • Fax: 419-255-2500
Mailing address:
  • Phone: 419-255-1115
  • Fax: 419-255-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP02197
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN270881
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: