Provider Demographics
NPI:1477605418
Name:QUINN, LORE A (NP)
Entity Type:Individual
Prefix:
First Name:LORE
Middle Name:A
Last Name:QUINN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7456 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:WI
Mailing Address - Zip Code:54893-8205
Mailing Address - Country:US
Mailing Address - Phone:715-866-4271
Mailing Address - Fax:715-866-4284
Practice Address - Street 1:7456 MAIN ST W
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:WI
Practice Address - Zip Code:54893-8205
Practice Address - Country:US
Practice Address - Phone:715-866-4271
Practice Address - Fax:715-866-4284
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI598-033363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43835500Medicaid
WIP01871Medicare UPIN
WI009045-0004Medicare ID - Type Unspecified