Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 702 | WY |
NPI | 1174836290 |
---|---|
Provider Name | Dr. Patrick Michael Quinn JR. |
First Address | Cheyenne, WY 82001 |
Second Address | Cheyenne, WY 82001-2745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2010 |
Last Update Date | 06/09/2010 |