MEDICARE: SHARON ANN QUEEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WX0800X	Orthopedic Registered Nurse	073515	TN

General Provider Information

NPI Number	:	1114697802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON ANN QUEEN

Provider Business Mailing Address
First Line	:	1421 BELLEVILLE AVE
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37803-3115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1421 BELLEVILLE AVE
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37803-3115
Country	:	US
Telephone Number	:	865-805-1930
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2021
Last Update Date	:	09/15/2021

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Directions to “ SHARON ANN QUEEN ” Practice Location

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