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NPI Code Detail

MEDICARE: LYNN D. QUILLAN N.P.

MEDICARE: LYNN D. QUILLAN N.P.
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
1363LW0102XWomen's Health Nurse Practitioner2392SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417905340
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNN D. QUILLAN N.P.
Provider Business Mailing Address
First Line : 300 E MCBEE AVE FL 4
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2842
Country : US
Telephone Number : 864-522-8614
Fax Number :
Provider Business Practice Location Address
First Line : 1120 GROVE RD
Second Line : SUITE B
City : GREENVILLE
State : SC
Zip : 29605-4656
Country : US
Telephone Number : 864-455-6444
Fax Number : 864-455-6598
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 05/13/2021

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