Healthcare Provider Details

I. General information

NPI: 1235803214
Provider Name (Legal Business Name): QUINN ADDISON CUMMINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 12/02/2025
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 HIGH ST
WILLIAMSPORT PA
17701-3100
US

IV. Provider business mailing address

1201 GRAMPIAN BLVD
WILLIAMSPORT PA
17701-1900
US

V. Phone/Fax

Practice location:
  • Phone: 570-321-2850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA062777
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: