Provider Demographics
NPI:1043755648
Name:AIMUYO, QUEEN (APRN)
Entity Type:Individual
Prefix:
First Name:QUEEN
Middle Name:
Last Name:AIMUYO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 SCRIPTURE ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2302
Mailing Address - Country:US
Mailing Address - Phone:940-484-4424
Mailing Address - Fax:940-484-4474
Practice Address - Street 1:2665 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2302
Practice Address - Country:US
Practice Address - Phone:940-484-4424
Practice Address - Fax:940-484-4474
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX562460YL7AMedicare PIN
TX562460YL7BMedicare PIN
TX562460YNGSMedicare PIN