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General NPI Number Information
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NPI Number | 1831441344
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Entity Type | Individual
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Provider Name | LINDA MACQUEEN NP
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Gender | Female
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 211 J.B. WISE PLAZA
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City | WATERTOWN
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State | NY
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Zip | 13601
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Country | US
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Telephone | 315-782-7445
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Fax | 315-779-1184
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Provider Business Mailing Address
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Address Line | 1575 WASHINGTON ST
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City | WATERTOWN
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State | NY
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Zip | 13601-9371
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Country | US
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Telephone | 315-779-5060
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Fax | 315-779-5028
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 401482
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License Number State | NY
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