Healthcare Provider Details

I. General information

NPI: 1538275482
Provider Name (Legal Business Name): LAURINDA L QUEEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 SUNSET RIDGE RD SUITE 202
RALEIGH NC
27607-6449
US

IV. Provider business mailing address

3921 SUNSET RIDGE RD SUITE 202
RALEIGH NC
27607-6449
US

V. Phone/Fax

Practice location:
  • Phone: 919-783-7877
  • Fax: 919-783-8042
Mailing address:
  • Phone: 919-783-7877
  • Fax: 919-783-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number26582
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: