Provider Demographics
NPI:1275552846
Name:CHEN, QUEENIE (RD)
Entity Type:Individual
Prefix:
First Name:QUEENIE
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 E LAREDO ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-5352
Mailing Address - Country:US
Mailing Address - Phone:480-577-7703
Mailing Address - Fax:
Practice Address - Street 1:1613 E LAREDO ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-5352
Practice Address - Country:US
Practice Address - Phone:480-577-7703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3752133V00000X
133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1528082948OtherGROUP NPI NUMBER
FL1528082948OtherGROUP NPI NUMBER