Healthcare Provider Details

I. General information

NPI: 1093798100
Provider Name (Legal Business Name): SUSAN S QUINN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WEST AVE S
LACROSSE WI
54601
US

IV. Provider business mailing address

800 WEST AVE S
LACROSSE WI
54601
US

V. Phone/Fax

Practice location:
  • Phone: 608-791-9866
  • Fax: 608-791-9897
Mailing address:
  • Phone: 617-573-2770
  • Fax: 617-573-2769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number34659
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: