MEDICARE: DORIS ANN QUEEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1750056511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORIS ANN QUEEN

Provider Business Mailing Address
First Line	:	3305 SPRING MOUNTAIN RD STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8629
Country	:	US
Telephone Number	:	702-882-8740
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 COASTAL BREEZE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4353
Country	:	US
Telephone Number	:	725-206-5714
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2021
Last Update Date	:	08/13/2021

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Directions to “ DORIS ANN QUEEN ” Practice Location

Language	Start Address	Practice Location

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