Healthcare Provider Details

I. General information

NPI: 1457744336
Provider Name (Legal Business Name): LAJUANA MCQUEEN WILLIS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAJUANA MCQUEEN R.N.

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 CHARTER DR #200
COLUMBIA MD
21044-3128
US

IV. Provider business mailing address

10710 CHARTER DR #200
COLUMBIA MD
21044-3128
US

V. Phone/Fax

Practice location:
  • Phone: 410-884-8000
  • Fax: 410-997-6019
Mailing address:
  • Phone: 410-884-8000
  • Fax: 410-997-6019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberR171824
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: