Provider Demographics
NPI:1376321364
Name:QUEEN-ALLEN, TARA LOREEN
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LOREEN
Last Name:QUEEN-ALLEN
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 1:7895 TALL PINES CT APT K
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5824
Mailing Address - Country:US
Mailing Address - Phone:240-704-4266
Mailing Address - Fax:
Practice Address - Street 1:7895 TALL PINES CT APT K
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5824
Practice Address - Country:US
Practice Address - Phone:240-704-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health