Provider Demographics
NPI:1740574268
Name:TANE, QUEEN
Entity Type:Individual
Prefix:
First Name:QUEEN
Middle Name:
Last Name:TANE
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 1:234 MEYER ST
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-2325
Mailing Address - Country:US
Mailing Address - Phone:832-786-9518
Mailing Address - Fax:
Practice Address - Street 1:12520 WESTHEIMER RD A-1 #201
Practice Address - Street 2:2307
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5567
Practice Address - Country:US
Practice Address - Phone:832-786-9518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker