Provider Demographics
NPI:1902359268
Name:QUEEN, JENA N (LAT)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:N
Last Name:QUEEN
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 LEGACY LAKES WAY
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-4999
Mailing Address - Country:US
Mailing Address - Phone:779-225-0992
Mailing Address - Fax:
Practice Address - Street 1:2298 LONGSTREET RD A
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-2491
Practice Address - Country:US
Practice Address - Phone:779-225-0992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer