Individual
SUSAN A. QUIMBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.,L.D.
Contact information
Practice address
805 STEVENS AVE, PORTLAND, ME 04103-2626
(207) 772-6279
(207) 347-4281
Mailing address
805 STEVENS AVE, PORTLAND, ME 04103-2626
(207) 772-6279
(207) 347-4281
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D121
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022185
ANTHEM
ME
01
—
11240707
CAQH
ME
01
—
3534992
AETNA
ME
Enumeration date
08/09/2006
Last updated
05/21/2015
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