MEDICARE: YATARRA M MCQUEEN

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	164W00000X	Licensed Practical Nurse	2-068893	AL

General Provider Information

NPI Number	:	1235994062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YATARRA M MCQUEEN

Provider Business Mailing Address
First Line	:	112 CHEEKWOOD DR
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-3016
Country	:	US
Telephone Number	:	334-531-1617
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 CHEEKWOOD DR
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-3016
Country	:	US
Telephone Number	:	334-531-1617
Fax Number	:

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

Provider Enumeration Date	:	02/20/2024
Last Update Date	:	12/03/2025

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