Provider Demographics
NPI:1114697802
Name:QUEEN, SHARON ANN
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
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 1:1421 BELLEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-3115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1421 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-3115
Practice Address - Country:US
Practice Address - Phone:865-805-1930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN073515163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedic