Basic Information
Provider Information
NPI: 1679971006
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CURTIS
FirstName: QUINN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3100 SPRING FOREST RD
Address2: STE 130
City: RALEIGH
State: NC
PostalCode: 276162880
CountryCode: US
TelephoneNumber: 9198739533
FaxNumber:  
Practice Location
Address1: 4420 LAKE BOONE TRL
Address2:  
City: RALEIGH
State: NC
PostalCode: 276077505
CountryCode: US
TelephoneNumber: 9197843100
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/17/2014
LastUpdateDate: 03/04/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X105735NCY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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