Healthcare Provider Details

I. General information

NPI: 1245143791
Provider Name (Legal Business Name): TAISA RAE QUINNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 HALE ST
WISCONSIN RAPIDS WI
54495-2787
US

IV. Provider business mailing address

700 HALE ST
WISCONSIN RAPIDS WI
54495-2787
US

V. Phone/Fax

Practice location:
  • Phone: 715-424-4682
  • Fax:
Mailing address:
  • Phone: 715-424-4682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number196415-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: