Provider Demographics
NPI:1235994062
Name:MCQUEEN, YATARRA M
Entity Type:Individual
Prefix:
First Name:YATARRA
Middle Name:M
Last Name:MCQUEEN
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 1:2411 COUNTY ROAD 20
Mailing Address - Street 2:
Mailing Address - City:SHORTER
Mailing Address - State:AL
Mailing Address - Zip Code:36075-3443
Mailing Address - Country:US
Mailing Address - Phone:334-531-1617
Mailing Address - Fax:
Practice Address - Street 1:2411 COUNTY ROAD 20
Practice Address - Street 2:
Practice Address - City:SHORTER
Practice Address - State:AL
Practice Address - Zip Code:36075-3443
Practice Address - Country:US
Practice Address - Phone:334-531-1617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-068893164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse