Healthcare Provider Details

I. General information

NPI: 1831441344
Provider Name (Legal Business Name): LINDA MACQUEEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 09/15/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 J.B. WISE PLAZA
WATERTOWN NY
13601
US

IV. Provider business mailing address

1575 WASHINGTON ST
WATERTOWN NY
13601-9371
US

V. Phone/Fax

Practice location:
  • Phone: 315-782-7445
  • Fax: 315-779-1184
Mailing address:
  • Phone: 315-779-5060
  • Fax: 315-779-5028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401482
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: