1164238606 NPI number — QUINN JESSA DEVALL

Table of content: QUINN JESSA DEVALL (NPI 1164238606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164238606 NPI number — QUINN JESSA DEVALL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEVALL
Provider First Name:
QUINN
Provider Middle Name:
JESSA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164238606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49926 866TH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INMAN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68742-4211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-340-1624
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49349 872ND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONEILL
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68763-5368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-340-1621
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2024

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: 372600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 26098136 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com