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General NPI Number Information
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NPI Number | 1336690478
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Entity Type | Individual
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Provider Name | JANIEL K DEROUCHEY-QUINN NP
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Gender | Female
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 801 N 29TH ST
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City | BILLINGS
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State | MT
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Zip | 59101-0905
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Country | US
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Telephone | 406-238-5046
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Fax |
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Provider Business Mailing Address
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Address Line | 724 LAZY M P.O.B. 2254
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City | RED LODGE
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State | MT
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Zip | 59068
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Country | US
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Telephone | 801-529-0872
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NUR-APRN-LIC-118569
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License Number State | MT
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