Provider Demographics
NPI:1407171994
Name:QUIROA, ESSIE MARIE (CMT)
Entity Type:Individual
Prefix:MRS
First Name:ESSIE
Middle Name:MARIE
Last Name:QUIROA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2937 LYNDALE AVE S STE 201
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2177
Mailing Address - Country:US
Mailing Address - Phone:612-418-5895
Mailing Address - Fax:612-879-8778
Practice Address - Street 1:2937 LYNDALE AVE S STE 201
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2177
Practice Address - Country:US
Practice Address - Phone:612-879-8000
Practice Address - Fax:612-879-8778
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNC94309696716174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist