Basic Information
| Provider Information | |||||||||
| NPI: | 1477605418 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUINN | ||||||||
| FirstName: | LORE | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7456 MAIN ST W | ||||||||
| Address2: | |||||||||
| City: | WEBSTER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548938205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158664271 | ||||||||
| FaxNumber: | 7158664284 | ||||||||
| Practice Location | |||||||||
| Address1: | 7456 MAIN ST W | ||||||||
| Address2: | |||||||||
| City: | WEBSTER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548938205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158664271 | ||||||||
| FaxNumber: | 7158664284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 06/30/2010 | ||||||||
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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 | 363LW0102X | 598-033 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 43835500 | 05 | WI | MEDICAID |