Provider Demographics
NPI:1679958300
Name:MCQUEENEY, DALE KRISTEN (FPMHNP)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:KRISTEN
Last Name:MCQUEENEY
Suffix:
Gender:F
Credentials:FPMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WINDSOR PL
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04274-7501
Mailing Address - Country:US
Mailing Address - Phone:207-998-4157
Mailing Address - Fax:
Practice Address - Street 1:1204 N AVE
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2464
Practice Address - Country:US
Practice Address - Phone:541-910-9929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202001101NP-PP363LP0808X
MECNP151054363LP0808X
NH075088-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health