Provider Demographics
NPI:1528411022
Name:MCQUEEN, SHARLEETA
Entity Type:Individual
Prefix:
First Name:SHARLEETA
Middle Name:
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 1:19354 KINLOCH
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-2604
Mailing Address - Country:US
Mailing Address - Phone:313-515-6960
Mailing Address - Fax:
Practice Address - Street 1:19354 KINLOCH
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-2604
Practice Address - Country:US
Practice Address - Phone:313-515-6960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI372500000XMedicare PIN