Provider Demographics
NPI:1457538811
Name:QUINN, CRYSTAL RENEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:RENEE
Last Name:QUINN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:CRYSTAL
Other - Middle Name:RENEE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:67 HARVEY PL
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-6036
Mailing Address - Country:US
Mailing Address - Phone:919-656-6947
Mailing Address - Fax:919-571-6455
Practice Address - Street 1:3100 DURALEIGH RD
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8106
Practice Address - Country:US
Practice Address - Phone:919-571-6465
Practice Address - Fax:919-571-6455
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC219752163W00000X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice