Provider Demographics
NPI:1679039465
Name:YOUNG-LEWIS, QUILLIAN (CNP)
Entity Type:Individual
Prefix:
First Name:QUILLIAN
Middle Name:
Last Name:YOUNG-LEWIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-3880
Mailing Address - Country:US
Mailing Address - Phone:575-434-0901
Mailing Address - Fax:833-918-0925
Practice Address - Street 1:2050 SCENIC DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-3880
Practice Address - Country:US
Practice Address - Phone:575-434-0901
Practice Address - Fax:833-918-0925
Is Sole Proprietor?:No
Enumeration Date:2019-02-16
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019000935363LF0000X
NMCNP-67508363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily