Provider Demographics
NPI:1164960217
Name:ARASAH, QUEEN (FNP)
Entity Type:Individual
Prefix:
First Name:QUEEN
Middle Name:
Last Name:ARASAH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7244 CEDRO
Mailing Address - Street 2:14
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-0104
Mailing Address - Country:US
Mailing Address - Phone:214-641-1304
Mailing Address - Fax:
Practice Address - Street 1:7244 CEDRO
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-0104
Practice Address - Country:US
Practice Address - Phone:214-641-1304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX661919163WC0200X
TXAP130844363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine