Provider Demographics
NPI:1871724732
Name:QUILLIN, KATIE MARIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:QUILLIN
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 1:37 ALICE DR
Mailing Address - Street 2:APT 95
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03303-2035
Mailing Address - Country:US
Mailing Address - Phone:603-290-2754
Mailing Address - Fax:
Practice Address - Street 1:37 ALICE DR
Practice Address - Street 2:APT 95
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03303-2035
Practice Address - Country:US
Practice Address - Phone:603-290-2754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker