1275322232 NPI number — BRIANNA MARIE QUENNEVILLE APRN

Table of content: BRIANNA MARIE QUENNEVILLE APRN (NPI 1275322232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275322232 NPI number — BRIANNA MARIE QUENNEVILLE APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUENNEVILLE
Provider First Name:
BRIANNA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
BRIANNA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1275322232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2113 FRONT RD N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMHERSTBURG
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
N9V 3R3
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2113 FRONT RD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMHERSTBURG
Provider Business Practice Location Address State Name:
ONTARIO
Provider Business Practice Location Address Postal Code:
N9V 3R3
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
519-992-8066
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  11037707 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 4704338544 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)