Provider Demographics
NPI:1013345347
Name:QUINLAN BETTENHAUSEN, DEBRA ANN (BSN, RN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:QUINLAN BETTENHAUSEN
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 KIMBER DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1131
Mailing Address - Country:US
Mailing Address - Phone:815-325-0949
Mailing Address - Fax:815-462-0949
Practice Address - Street 1:5250 NORTH OLD ORCHARD ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:847-763-1791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.279872163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management