Provider Demographics
NPI:1497496772
Name:QUINN, KIMBERLY G
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:G
Last Name:QUINN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 TWINLEAF WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE FREDERICK
Mailing Address - State:VA
Mailing Address - Zip Code:22630-2292
Mailing Address - Country:US
Mailing Address - Phone:540-532-8933
Mailing Address - Fax:
Practice Address - Street 1:500 PEGASUS CT STE 508
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-4596
Practice Address - Country:US
Practice Address - Phone:800-805-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-02
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002074617164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse