Provider Demographics
NPI:1710743992
Name:QUIRK, LISA MIRABELLA (SPECIALIST)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MIRABELLA
Last Name:QUIRK
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:983 JOHN LEO DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2365
Mailing Address - Country:US
Mailing Address - Phone:585-355-1561
Mailing Address - Fax:
Practice Address - Street 1:983 JOHN LEO DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2365
Practice Address - Country:US
Practice Address - Phone:585-355-1561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist