Provider Demographics
NPI:1245600766
Name:QUINN, JENNIFER KATE (DOM)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:KATE
Last Name:QUINN
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOM
Mailing Address - Street 1:921 NASHVILLE SW APT. 2
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105
Mailing Address - Country:US
Mailing Address - Phone:505-307-9960
Mailing Address - Fax:
Practice Address - Street 1:921 NASHVILLE AVE SW APT 2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-3899
Practice Address - Country:US
Practice Address - Phone:505-307-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-26
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1056171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist