Provider Demographics
NPI:1164808317
Name:NFOR, QUINTA (AGNP-DNP)
Entity Type:Individual
Prefix:
First Name:QUINTA
Middle Name:
Last Name:NFOR
Suffix:
Gender:F
Credentials:AGNP-DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12555 W NATIONAL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-4061
Mailing Address - Country:US
Mailing Address - Phone:262-754-2555
Mailing Address - Fax:262-754-2552
Practice Address - Street 1:12555 W NATIONAL AVE STE 200
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-4061
Practice Address - Country:US
Practice Address - Phone:262-754-2555
Practice Address - Fax:262-754-2552
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6418-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner