Provider Demographics
NPI:1265029748
Name:QUAMME, CAITLYN NICOLE
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:NICOLE
Last Name:QUAMME
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 1:100 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3914
Mailing Address - Country:US
Mailing Address - Phone:701-837-8283
Mailing Address - Fax:701-575-7207
Practice Address - Street 1:100 MAIN ST S
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3914
Practice Address - Country:US
Practice Address - Phone:701-837-8283
Practice Address - Fax:701-575-7207
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRBT-20-148887106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician