Healthcare Provider Details

I. General information

NPI: 1386241701
Provider Name (Legal Business Name): MELANIE MARIE MCQUEEN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 WILLIAMS DR STE 108
GEORGETOWN TX
78628-2748
US

IV. Provider business mailing address

5303 50TH ST
LUBBOCK TX
79414-1817
US

V. Phone/Fax

Practice location:
  • Phone: 737-808-0717
  • Fax: 806-785-4327
Mailing address:
  • Phone: 806-799-1484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number81283
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number81283
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: