1730278276 NPI number — DR. TAMARA QUINLAN NELSON D.C.

Table of content: DR. TAMARA QUINLAN NELSON D.C. (NPI 1730278276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730278276 NPI number — DR. TAMARA QUINLAN NELSON D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
TAMARA
Provider Middle Name:
QUINLAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
QUINLAN
Provider Other First Name:
TAMARA
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730278276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
534 WEDGEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAHTOMEDI
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55115-1790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-720-4805
Provider Business Mailing Address Fax Number:
612-206-8595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 HIGHWAY 96 E STE 212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE BEAR LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55110-3619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-720-4805
Provider Business Practice Location Address Fax Number:
612-206-8595
Provider Enumeration Date:
10/12/2006

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: 111N00000X , with the licence number:  3604 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 618323900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".