Provider Demographics
NPI:1750504122
Name:QUIGGLE, NANCY LU (PHD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LU
Last Name:QUIGGLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-6217
Mailing Address - Country:US
Mailing Address - Phone:650-591-3636
Mailing Address - Fax:650-591-3600
Practice Address - Street 1:957 INDUSTRIAL RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-4151
Practice Address - Country:US
Practice Address - Phone:415-375-7590
Practice Address - Fax:650-620-9549
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19871103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical