Provider Demographics
NPI:1639845738
Name:SPILLMAN, QURAN
Entity Type:Individual
Prefix:
First Name:QURAN
Middle Name:
Last Name:SPILLMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 WILHELMINA RISE APT A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3256
Mailing Address - Country:US
Mailing Address - Phone:847-962-8838
Mailing Address - Fax:
Practice Address - Street 1:2 AARONA PL STE 208
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2545
Practice Address - Country:US
Practice Address - Phone:847-962-8838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician