Provider Demographics
NPI:1770242935
Name:MCQUEEN, GABRIEL
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:MCQUEEN
Suffix:
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 1:8601 E 11TH CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-2275
Mailing Address - Country:US
Mailing Address - Phone:907-885-4327
Mailing Address - Fax:907-222-9984
Practice Address - Street 1:8601 E 11TH CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2275
Practice Address - Country:US
Practice Address - Phone:907-884-0289
Practice Address - Fax:907-278-1268
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK24762171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator