MEDICARE: MRS. MARIE E MCQUEEN ANP,BC

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	13062	AK
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	250	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265436752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIE E MCQUEEN ANP,BC

Provider Business Mailing Address
First Line	:	920 W DIMOND BLVD # 1
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-1502
Country	:	US
Telephone Number	:	907-349-0077
Fax Number	:	907-349-0078

Provider Business Practice Location Address
First Line	:	920 W DIMOND BLVD # 1
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-1502
Country	:	US
Telephone Number	:	907-349-0077
Fax Number	:	907-349-0078

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	01/07/2008

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