Provider Demographics
NPI:1497346522
Name:QUINN, CAITLYN (RN, PHN)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14189 ARMSTRONG WOODS RD
Mailing Address - Street 2:
Mailing Address - City:GUERNEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95446-9511
Mailing Address - Country:US
Mailing Address - Phone:386-847-2542
Mailing Address - Fax:
Practice Address - Street 1:625 5TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4428
Practice Address - Country:US
Practice Address - Phone:707-696-6934
Practice Address - Fax:707-565-4430
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95226091163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse