Provider Demographics
NPI:1235306788
Name:QUAKENBUSH, STEVEN (PA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:QUAKENBUSH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 E HWY 50
Mailing Address - Street 2:SUITE E
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-9342
Mailing Address - Country:US
Mailing Address - Phone:719-285-2888
Mailing Address - Fax:719-285-2889
Practice Address - Street 1:3245 E HWY 50
Practice Address - Street 2:SUITE E
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-9342
Practice Address - Country:US
Practice Address - Phone:719-285-2888
Practice Address - Fax:719-285-2889
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical