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General NPI Number Information
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NPI Number | 1902359268
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Entity Type | Individual
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Provider Name | JENA N QUEEN LAT
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Gender | Female
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 2-5818 BUTNER RD
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City | FORT BRAGG
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State | NC
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Zip | 28310-2491
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Country | US
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Telephone | 779-225-0992
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Fax |
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Provider Business Mailing Address
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Address Line | 241 TORMORE DR
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City | SANFORD
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State | NC
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Zip | 27330-7118
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Country | US
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Telephone | 779-225-0992
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | LAT-5474
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096004637
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License Number State | IL
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