1033481957 NPI number — MRS. DESIREE DAWN QUINN FNP

Table of content: MRS. DESIREE DAWN QUINN FNP (NPI 1033481957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033481957 NPI number — MRS. DESIREE DAWN QUINN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUINN
Provider First Name:
DESIREE
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PROCINSKY
Provider Other First Name:
DESIREE
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033481957
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 ASBURY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77007-8103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-501-0796
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 HOPYARD RD #100
Provider Second Line Business Practice Location Address:
TEAM HEALTH
Provider Business Practice Location Address City Name:
PLEASANTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-924-1600
Provider Business Practice Location Address Fax Number:
925-924-0506
Provider Enumeration Date:
02/08/2012

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: 363LF0000X , with the licence number:  764355 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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