MEDICARE: QUIN LOREN MCPHERRON

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	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1801153838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUIN LOREN MCPHERRON

Provider Business Mailing Address
First Line	:	3 HYANNIS PORT PLACE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95835
Country	:	US
Telephone Number	:	916-622-4909
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 HYANNIS PORT PLACE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95835
Country	:	US
Telephone Number	:	916-622-4909
Fax Number	:

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

Provider Enumeration Date	:	04/16/2012
Last Update Date	:	04/16/2012

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