Provider Demographics
NPI:1396385878
Name:MCQUEEN, JEROME JR
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:MCQUEEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 ELMIRA ST SW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-2248
Mailing Address - Country:US
Mailing Address - Phone:202-997-7677
Mailing Address - Fax:
Practice Address - Street 1:67 ELMIRA ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2248
Practice Address - Country:US
Practice Address - Phone:202-997-7677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant