Provider Demographics
NPI:1033667381
Name:MCQUAITE, KORIE BROOKE (PA-C)
Entity Type:Individual
Prefix:
First Name:KORIE
Middle Name:BROOKE
Last Name:MCQUAITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KORIE
Other - Middle Name:BROOKE
Other - Last Name:BRUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2152 S VINEYARD STE 138
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6882
Mailing Address - Country:US
Mailing Address - Phone:480-539-6646
Mailing Address - Fax:480-539-6696
Practice Address - Street 1:2152 S VINEYARD STE 138
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6882
Practice Address - Country:US
Practice Address - Phone:480-539-6646
Practice Address - Fax:480-539-6696
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059832363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant