Individual
SHANNON QUIRK DETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2880 FOLSOM ST STE 200, BOULDER, CO 80304-3769
(303) 442-6647
(303) 442-2696
Mailing address
600 HIGHLAND AVE, MADISON, WI 53792-0001
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
6600-851
WI
207N00000X
Dermatology Physician
Primary
70147
WI
Other
Enumeration date
04/06/2016
Last updated
10/07/2022
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