MEDICARE: MRS. TONYA SUE QUEEN NP-C

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	363LW0102X	Women's Health Nurse Practitioner	71006746A	IN
2	363LF0000X	Family Nurse Practitioner	71006747A	IN

General Provider Information

NPI Number	:	1295279149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TONYA SUE QUEEN NP-C

Provider Business Mailing Address
First Line	:	320 E COUNTY ROAD 300 N
Second Line	:
City	:	SULLIVAN
State	:	IN
Zip	:	47882-7561
Country	:	US
Telephone Number	:	812-239-8178
Fax Number	:

Provider Business Practice Location Address
First Line	:	1602 UPPER 11TH ST
Second Line	:
City	:	VINCENNES
State	:	IN
Zip	:	47591-4820
Country	:	US
Telephone Number	:	812-886-4557
Fax Number	:

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

Provider Enumeration Date	:	12/12/2016
Last Update Date	:	10/21/2025

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