Basic Information
Provider Information
NPI: 1649596289
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: QUINLAN
FirstName: JO-ELLEN
MiddleName: M.
NamePrefix: MS.
NameSuffix:  
Credential: PNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 97 EVERETT ST
Address2:  
City: ARLINGTON
State: MA
PostalCode: 024746921
CountryCode: US
TelephoneNumber: 8888978947
FaxNumber: 6177725519
Practice Location
Address1: 253 SUMMER ST
Address2: 5TH FLOOR-CMA
City: BOSTON
State: MA
PostalCode: 022101114
CountryCode: US
TelephoneNumber: 8888978947
FaxNumber: 6177725519
Other Information
ProviderEnumerationDate: 04/07/2010
LastUpdateDate: 04/07/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X112947MAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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