Provider Demographics
NPI:1376256727
Name:QUEEN, ARLINDA SUE
Entity Type:Individual
Prefix:
First Name:ARLINDA
Middle Name:SUE
Last Name:QUEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ARLINDA
Other - Middle Name:SUE
Other - Last Name:QUEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1908
Mailing Address - Country:US
Mailing Address - Phone:304-525-5151
Mailing Address - Fax:
Practice Address - Street 1:540 5TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1908
Practice Address - Country:US
Practice Address - Phone:304-525-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0000Medicaid