Healthcare Provider Details

I. General information

NPI: 1750308110
Provider Name (Legal Business Name): KIMBERLY A QUEENER DNP CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

1956 E SPRING VALLEY PIKE
DAYTON OH
45458-2800
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-6173
  • Fax:
Mailing address:
  • Phone: 593-741-6365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN167488
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: