Provider Demographics
NPI:1134750631
Name:QUINN, MICHELLE RENAE (RN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENAE
Last Name:QUINN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:RENAE
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:38 IBIZA AISLE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-0267
Mailing Address - Country:US
Mailing Address - Phone:517-927-4156
Mailing Address - Fax:
Practice Address - Street 1:38 IBIZA AISLE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-0267
Practice Address - Country:US
Practice Address - Phone:517-927-4156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA735883163W00000X
CANP95016949363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse