Provider Demographics
NPI:1962451963
Name:QUICK, SHAWN (FNP)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:QUICK
Suffix:
Gender:F
Credentials:FNP
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 983
Mailing Address - Street 2:176 CAMINO BACA GRANDE
Mailing Address - City:CRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:81131-0983
Mailing Address - Country:US
Mailing Address - Phone:719-256-5118
Mailing Address - Fax:719-256-5518
Practice Address - Street 1:176 CAMINO BACA GRANDE,
Practice Address - Street 2:
Practice Address - City:CRESTONE
Practice Address - State:CO
Practice Address - Zip Code:81131-0983
Practice Address - Country:US
Practice Address - Phone:719-256-5118
Practice Address - Fax:719-256-5518
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO112719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily