Provider Information for 1760159438
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CAROL ANN QUEEN
Sex: Female
NPI: 1760159438
Last Updated: 2023-09-25
Certification Date: 2023-09-25
Certification Date: 2023-09-25
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1760159438 | ||||||||
| Enumeration Date | 2021-08-30 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 632 GIBSON RD MEBANE, NC 27302-9130 United States Phone: 760-267-7495 | Fax: | ||||||||
| Primary Practice Address | 632 GIBSON RD MEBANE, NC 27302-9130 United States Phone: 760-267-7495 | Fax: | ||||||||
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