Provider Demographics
NPI:1700615929
Name:QUIRK, MELISSA RAE
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RAE
Last Name:QUIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15971 470TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:OSLO
Mailing Address - State:MN
Mailing Address - Zip Code:56744-9435
Mailing Address - Country:US
Mailing Address - Phone:701-620-9634
Mailing Address - Fax:
Practice Address - Street 1:715 N 43RD ST APT 101
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-1942
Practice Address - Country:US
Practice Address - Phone:701-620-9634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker