Provider Demographics
NPI:1336690478
Name:DEROUCHEY-QUINN, JANIEL K (NP)
Entity Type:Individual
Prefix:
First Name:JANIEL
Middle Name:K
Last Name:DEROUCHEY-QUINN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANIEL
Other - Middle Name:K
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:724 LAZY M
Mailing Address - Street 2:P.O.B. 2254
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068
Mailing Address - Country:US
Mailing Address - Phone:801-529-0872
Mailing Address - Fax:
Practice Address - Street 1:801 N 29TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0905
Practice Address - Country:US
Practice Address - Phone:406-238-5046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-118569363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner