Healthcare Provider Details

I. General information

NPI: 1144694118
Provider Name (Legal Business Name): CHRISTIE QUIGLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 HAMILTON ST
PHILADELPHIA PA
19130-3814
US

IV. Provider business mailing address

2100 PINE ST APT 2F
PHILADELPHIA PA
19103-6554
US

V. Phone/Fax

Practice location:
  • Phone: 215-567-2017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN661978
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0045591
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSPP015523
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: