Provider Demographics
NPI:1023063401
Name:KNEIFL, QUINN M (PA-C)
Entity type:Individual
Prefix:
First Name:QUINN
Middle Name:M
Last Name:KNEIFL
Suffix:
Gender:F
Credentials:PA-C
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 100
Mailing Address - Street 2:
Mailing Address - City:PENDER
Mailing Address - State:NE
Mailing Address - Zip Code:68047-0100
Mailing Address - Country:US
Mailing Address - Phone:402-385-4004
Mailing Address - Fax:402-385-4041
Practice Address - Street 1:958 WELLNESS WAY STE 1
Practice Address - Street 2:
Practice Address - City:PENDER
Practice Address - State:NE
Practice Address - Zip Code:68047-4518
Practice Address - Country:US
Practice Address - Phone:402-385-3033
Practice Address - Fax:402-385-3092
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1178363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE278960Medicare PIN
Q44978Medicare UPIN