Provider Demographics
NPI:1154094852
Name:QUINLAN, KENNEDY MARIE
Entity Type:Individual
Prefix:
First Name:KENNEDY
Middle Name:MARIE
Last Name:QUINLAN
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 1:305 N SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:OH
Mailing Address - Zip Code:45030-1179
Mailing Address - Country:US
Mailing Address - Phone:513-335-3304
Mailing Address - Fax:
Practice Address - Street 1:305 N SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-1179
Practice Address - Country:US
Practice Address - Phone:513-335-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker