=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700036506
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHEILA QUINN PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2008
-----------------------------------------------------
Last Update Date | 06/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 640 W MOANA LN STE 2
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89509-4857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-324-0633
-----------------------------------------------------
Fax | 775-323-6814
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3950 G.S. RICHARDS BLVD
-----------------------------------------------------
City | CARSON CITY
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 87903-8457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-324-0633
-----------------------------------------------------
Fax | 775-323-6814
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA1085
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------