Provider Demographics
NPI:1043059850
Name:WISE-DORBOLO, QUINCY IRIS
Entity type:Individual
Prefix:
First Name:QUINCY
Middle Name:IRIS
Last Name:WISE-DORBOLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10375
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-2375
Mailing Address - Country:US
Mailing Address - Phone:541-505-1139
Mailing Address - Fax:
Practice Address - Street 1:1270 CHARNELTON ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3430
Practice Address - Country:US
Practice Address - Phone:541-505-1139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula