Provider Demographics
NPI:1396777132
Name:QUINLAN, JANINE (NP)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:QUINLAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8382 WICKHAM BLVD
Mailing Address - Street 2:
Mailing Address - City:SODUS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:14555-9608
Mailing Address - Country:US
Mailing Address - Phone:315-945-9831
Mailing Address - Fax:
Practice Address - Street 1:1519 NYE RD
Practice Address - Street 2:WAYNE BEHAVIORAL NETWORK SUITE 1000
Practice Address - City:LYONS
Practice Address - State:NY
Practice Address - Zip Code:14489-9133
Practice Address - Country:US
Practice Address - Phone:315-946-5722
Practice Address - Fax:315-946-5726
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400618363LP0808X
NYF360186363LX0001X
NYF000377367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR82239Medicare UPIN