Basic Information
| Provider Information | |||||||||
| NPI: | 1144675729 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUINN | ||||||||
| FirstName: | ALISON | ||||||||
| MiddleName: | NICOLE VAN PELT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 MADISON AVE | ||||||||
| Address2: | SUITE 447 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381033438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014482302 | ||||||||
| FaxNumber: | 9014481691 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY OF TENNESSEE 920 MADISON AVE | ||||||||
| Address2: | SUITE 447 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381630001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014482302 | ||||||||
| FaxNumber: | 9014481477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2016 | ||||||||
| LastUpdateDate: | 05/02/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.