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General NPI Number Information
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NPI Number | 1942967294
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Entity Type | Individual
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Provider Name | NICOLE LYNN MCQUILLAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/22/2021
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Last Update Date | 11/26/2021
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Provider Practice Location Address
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Address Line | 111 S FRONT ST
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City | HARRISBURG
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State | PA
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Zip | 17101-2010
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Country | US
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Telephone | 717-988-0000
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Fax | 717-782-5716
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Provider Business Mailing Address
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Address Line | 604 STONEY RUN RD
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City | POTTSVILLE
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State | PA
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Zip | 17901-8729
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Country | US
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Telephone | 570-933-0890
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 063183
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 005930
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License Number State | PA
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