Provider Demographics
NPI:1871539759
Name:QUINTON, SHELLY JO (ARNP)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:JO
Last Name:QUINTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 W FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WA
Mailing Address - Zip Code:99111-9552
Mailing Address - Country:US
Mailing Address - Phone:509-397-4717
Mailing Address - Fax:509-397-3501
Practice Address - Street 1:1210 W FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WA
Practice Address - Zip Code:99111-9552
Practice Address - Country:US
Practice Address - Phone:509-397-4717
Practice Address - Fax:509-397-3501
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS59120Medicare UPIN
WAGAB04904Medicare PIN
WA0946290001Medicare NSC