Healthcare Provider Details

I. General information

NPI: 1265436752
Provider Name (Legal Business Name): MARIE E MCQUEEN ANP,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 W DIMOND BLVD # 1
ANCHORAGE AK
99515-1502
US

IV. Provider business mailing address

920 W DIMOND BLVD # 1
ANCHORAGE AK
99515-1502
US

V. Phone/Fax

Practice location:
  • Phone: 907-349-0077
  • Fax: 907-349-0078
Mailing address:
  • Phone: 907-349-0077
  • Fax: 907-349-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number13062
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number250
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: