MEDICARE: MS. EJEANEE D. QUEEN RN, FNP

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	363LF0000X	Family Nurse Practitioner	735724	TX

General Provider Information

NPI Number	:	1982749123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EJEANEE D. QUEEN RN, FNP

Provider Business Mailing Address
First Line	:	1000 E PLEASANT RUN RD
Second Line	:	#4633
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-5513
Country	:	US
Telephone Number	:	214-421-7848
Fax Number	:	214-421-1119

Provider Business Practice Location Address
First Line	:	1906 PEABODY AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-2821
Country	:	US
Telephone Number	:	214-421-7848
Fax Number	:	214-421-1119

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/08/2007

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