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General NPI Number Information
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NPI Number | 1205658119
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Entity Type | Individual
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Provider Name | OLIVIA M QUEEN
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Gender | Female
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 283 CONSTITUTION DR STE 600
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-6760
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Country | US
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Telephone | 757-250-7725
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Fax |
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Provider Business Mailing Address
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Address Line | 7437 SEAL BEACH CT
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City | CORPUS CHRISTI
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State | TX
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Zip | 78414-4461
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Country | US
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Telephone | 928-234-1039
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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