Provider Demographics
NPI:1437862653
Name:QUINN MINTHORN, BRANDT OWEN (CRM)
Entity Type:Individual
Prefix:
First Name:BRANDT
Middle Name:OWEN
Last Name:QUINN MINTHORN
Suffix:
Gender:M
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 882
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0882
Mailing Address - Country:US
Mailing Address - Phone:541-429-8844
Mailing Address - Fax:541-429-8822
Practice Address - Street 1:200 SE HAILEY AVE STE 106
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3072
Practice Address - Country:US
Practice Address - Phone:541-429-8844
Practice Address - Fax:541-429-8822
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-CRM-1440175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR22-CRM-1440OtherMHACBO