MEDICARE: TERESA VICTORIA QUINONES RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	400456-1	NY
2	163W00000X	Registered Nurse	26NR10343900	NJ

General Provider Information

NPI Number	:	1417300971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA VICTORIA QUINONES RN

Provider Business Mailing Address
First Line	:	2846 HEATH AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-7802
Country	:	US
Telephone Number	:	347-374-1245
Fax Number	:

Provider Business Practice Location Address
First Line	:	2846 HEATH AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-7802
Country	:	US
Telephone Number	:	347-374-1245
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	07/20/2016

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