Provider Demographics
NPI:1659519775
Name:QUISTORFF, HANS ALBERT (LMP)
Entity Type:Individual
Prefix:
First Name:HANS
Middle Name:ALBERT
Last Name:QUISTORFF
Suffix:
Gender:M
Credentials:LMP
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 65
Mailing Address - Street 2:
Mailing Address - City:WAUNA
Mailing Address - State:WA
Mailing Address - Zip Code:98395-0065
Mailing Address - Country:US
Mailing Address - Phone:253-851-4212
Mailing Address - Fax:
Practice Address - Street 1:13414 138TH AVENUE KP N
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98329-5303
Practice Address - Country:US
Practice Address - Phone:253-851-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA OOOO8159174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist