Basic Information
| Provider Information | |||||||||
| NPI: | 1174660849 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUINLAN | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 422 28TH ST SW | ||||||||
| Address2: | |||||||||
| City: | MASON CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504016416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6412011638 | ||||||||
| FaxNumber: | 6414246709 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 4TH ST SW | ||||||||
| Address2: | |||||||||
| City: | MASON CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504012800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414287108 | ||||||||
| FaxNumber: | 6414287088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 05/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 074062 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 430076177 | 01 | MN | RR MEDICARE | OTHER |