MEDICARE: GAIL NICOLE 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1982335162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL NICOLE QUEEN

Provider Business Mailing Address
First Line	:	202 GARFIELD ST
Second Line	:
City	:	LIBERTY CENTER
State	:	OH
Zip	:	43532-9337
Country	:	US
Telephone Number	:	740-751-1711
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 GARFIELD ST
Second Line	:
City	:	LIBERTY CENTER
State	:	OH
Zip	:	43532-9337
Country	:	US
Telephone Number	:	740-751-1711
Fax Number	:

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

Provider Enumeration Date	:	06/20/2022
Last Update Date	:	06/20/2022

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Directions to “ GAIL NICOLE QUEEN ” Practice Location

Language	Start Address	Practice Location

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