Provider Demographics
NPI:1023503570
Name:MCQUILLIN, STEPHANIE RAE (APRN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAE
Last Name:MCQUILLIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1751 E GARDNER WAY STE E
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6564
Mailing Address - Country:US
Mailing Address - Phone:907-376-9321
Mailing Address - Fax:907-376-9322
Practice Address - Street 1:1751 E GARDNER WAY STE E
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6564
Practice Address - Country:US
Practice Address - Phone:907-376-9321
Practice Address - Fax:907-376-9322
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK133098363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily