Provider Demographics
NPI:1174613012
Name:WAHLIN-QUINLAN, SHELLEY (PA-C)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:WAHLIN-QUINLAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 HILLIGOSS BLVD SE
Mailing Address - Street 2:
Mailing Address - City:FOSSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56542-1542
Mailing Address - Country:US
Mailing Address - Phone:218-435-1133
Mailing Address - Fax:218-435-1134
Practice Address - Street 1:900 HILLIGOSS BLVD SE
Practice Address - Street 2:
Practice Address - City:FOSSTON
Practice Address - State:MN
Practice Address - Zip Code:56542-1542
Practice Address - Country:US
Practice Address - Phone:218-435-1133
Practice Address - Fax:218-435-1134
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9212363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN253K1WAOtherBLUE PLUS NUMBER
MN0120973OtherMEDICA NUMBER
MN06Q07TUOtherBLUE CROSS NUMBER
MNHP36798OtherHEALTHPARTNERS NUMBER
MN1017203OtherPREFERRED ONE NUMBER
MN253K1WAOtherBLUE PLUS NUMBER