Healthcare Provider Details

I. General information

NPI: 1639642416
Provider Name (Legal Business Name): ELIZABETH QUEEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 MORSE RD
COLUMBUS OH
43229-5858
US

IV. Provider business mailing address

595 SCIOTO MEADOWS BLVD
GROVE CITY OH
43123-8654
US

V. Phone/Fax

Practice location:
  • Phone: 614-702-7899
  • Fax: 614-706-1570
Mailing address:
  • Phone: 614-204-4721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN.407599
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024127
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: