Healthcare Provider Details

I. General information

NPI: 1831226869
Provider Name (Legal Business Name): LUCILLE M QUEENEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10350 E DAKOTA AVE
DENVER CO
80247-1314
US

IV. Provider business mailing address

5800 W 50TH AVE
DENVER CO
80212-2806
US

V. Phone/Fax

Practice location:
  • Phone: 303-743-5855
  • Fax:
Mailing address:
  • Phone: 303-425-3537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number21818
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: