Provider Demographics
NPI:1619155140
Name:QUINN, ESTHER W (MS,RD)
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:W
Last Name:QUINN
Suffix:
Gender:F
Credentials:MS,RD
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 885
Mailing Address - Street 2:
Mailing Address - City:PRENTISS
Mailing Address - State:MS
Mailing Address - Zip Code:39474-0885
Mailing Address - Country:US
Mailing Address - Phone:601-792-9175
Mailing Address - Fax:
Practice Address - Street 1:729 MAPP TURNER RD
Practice Address - Street 2:
Practice Address - City:OAK VALE
Practice Address - State:MS
Practice Address - Zip Code:39656-7042
Practice Address - Country:US
Practice Address - Phone:601-792-9175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSDO365133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1952599862OtherNPI