Provider Demographics
NPI:1023546363
Name:MACKLIN, QUINNTRELL (CNIM)
Entity Type:Individual
Prefix:
First Name:QUINNTRELL
Middle Name:
Last Name:MACKLIN
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5001 ROWLETT RD STE 301
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-3602
Mailing Address - Country:US
Mailing Address - Phone:469-440-8841
Mailing Address - Fax:
Practice Address - Street 1:5001 ROWLETT RD STE 301
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-3602
Practice Address - Country:US
Practice Address - Phone:469-440-8841
Practice Address - Fax:210-598-4236
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic