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General NPI Number Information
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NPI Number | 1992457550
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Entity Type | Organization
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Legal Business Name | QUEEN CITY LABORATORY SERVICES, PLLC
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 10150 MALLARD CREEK RD STE 104
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City | CHARLOTTE
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State | NC
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Zip | 28262-4567
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Country | US
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Telephone | 240-468-9428
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Fax |
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Provider Business Mailing Address
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Address Line | 10150 MALLARD CREEK RD STE 104
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City | CHARLOTTE
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State | NC
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Zip | 28262-4567
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEENA DREW
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Credential | DNP, FNP-C
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Telephone | 240-468-9428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0001X
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Taxonomy Name | Clinical & Laboratory Immunology (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246QL0900X
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Taxonomy Name | Laboratory Management Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 246QL0901X
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Taxonomy Name | Diplomate Laboratory Management Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 246RM2200X
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Taxonomy Name | Medical Laboratory Technician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number |
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License Number State |
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