Provider Demographics
NPI:1609129543
Name:QUINLAN, JESSICA RENEE (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:QUINLAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62162 CROWN POINT RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:OR
Mailing Address - Zip Code:97420-7606
Mailing Address - Country:US
Mailing Address - Phone:541-888-3191
Mailing Address - Fax:
Practice Address - Street 1:1775 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2125
Practice Address - Country:US
Practice Address - Phone:541-267-1962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR083039534RN163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator