Provider Demographics
NPI:1053468629
Name:QUINLIVAN, GINA M
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:M
Last Name:QUINLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 N MAIN ST
Mailing Address - Street 2:STE 205
Mailing Address - City:E LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1830
Mailing Address - Country:US
Mailing Address - Phone:508-882-3141
Mailing Address - Fax:
Practice Address - Street 1:382 N MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028
Practice Address - Country:US
Practice Address - Phone:134-794-8484
Practice Address - Fax:413-794-5910
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA195514367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife