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NPI Code Detail

MEDICARE: MICHELLE LOURDES QUEEN FNP-C

MEDICARE: MICHELLE LOURDES QUEEN FNP-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
1363LA2100XAcute Care Nurse PractitionerRN159750GA
2363L00000XNurse PractitionerRN159750GA
3163W00000XRegistered NurseRN159750GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RN159750OTHERGASTATE OF GEORGIA BOARD OF NURSING
2F0508073OTHERGAAMERICAN ACADEMY OF NURSE PRACTITIONERS CERT PROGRAM

General Provider Information

NPI Number : 1861656365
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE LOURDES QUEEN FNP-C
Provider Business Mailing Address
First Line : 460 NORTHSIDE CHEROKEE BLVD STE 130
Second Line :
City : CANTON
State : GA
Zip : 30115-8017
Country : US
Telephone Number : 678-493-2527
Fax Number : 678-493-5608
Provider Business Practice Location Address
First Line : 960 JOE FRANK HARRIS PKWY SE
Second Line :
City : CARTERSVILLE
State : GA
Zip : 30120-2129
Country : US
Telephone Number : 470-490-2142
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2008
Last Update Date : 09/18/2025

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Directions to “ MICHELLE LOURDES QUEEN FNP-C” Practice Location

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