Healthcare Provider Details

I. General information

NPI: 1073238846
Provider Name (Legal Business Name): NICOLE QUEEN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9506 HARFORD RD
PARKVILLE MD
21234-3113
US

IV. Provider business mailing address

9506 HARFORD RD
PARKVILLE MD
21234-3113
US

V. Phone/Fax

Practice location:
  • Phone: 443-703-8345
  • Fax: 410-305-6221
Mailing address:
  • Phone: 443-673-7985
  • Fax: 410-305-6221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberR200798
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR200798
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR200798
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: