Individual
JULISSA QUINTANILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
444 SW CENTER ST, FAISON, NC 28341-8820
(910) 267-0421
(910) 378-1746
Mailing address
PO BOX 187, FAISON, NC 28341-0187
(910) 267-2042
(855) 996-9090
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-14568
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/17/2024
Last updated
09/23/2024
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