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General NPI Number Information
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NPI Number | 1659423184
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Entity Type | Individual
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Provider Name | DEBRA RENEE QUEEN R.D.
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 400 S LEWIS LN
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City | CARBONDALE
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State | IL
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Zip | 62901-3547
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Country | US
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Telephone | 618-519-9200
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Fax | 618-519-9961
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Provider Business Mailing Address
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Address Line | 109 CALIFORNIA ST PO BOX 577
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City | CARTERVILLE
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State | IL
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Zip | 62918
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Country | US
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Telephone | 618-519-9200
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1025
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 164.006191
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LD718
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License Number State | OK
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