Provider Demographics
NPI:1083030753
Name:QUEEN, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:QUEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 LEAVENWORTH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1026
Mailing Address - Country:US
Mailing Address - Phone:402-341-5128
Mailing Address - Fax:402-505-9849
Practice Address - Street 1:4001 LEAVENWORTH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1026
Practice Address - Country:US
Practice Address - Phone:402-341-5128
Practice Address - Fax:402-505-9849
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator