Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD60570885 | WA |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PT16025 | ND |
NPI | 1063442804 |
---|---|
Provider Name | Susan Quigley |
First Address | Seattle, WA 98102-3203 |
Second Address | Fargo, ND 58102-4421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 04/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201230330 | (05) | IN |
802719600 | (05) | MN |
G80216 | (02) |