=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073427498
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUEENKEE UNIVERSAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2026
-----------------------------------------------------
Last Update Date | 10/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1633 HENRICO ARMS ST APT A
-----------------------------------------------------
City | HENRICO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23231-3841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-582-9720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1633 HENRICO ARMS ST APT A
-----------------------------------------------------
City | HENRICO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23231-3841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-582-9720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGING
-----------------------------------------------------
Name | MARCIA NAKKIA MCNEAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-582-9720
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246RP1900X
-----------------------------------------------------
Taxonomy Name | Phlebotomy Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------