Provider Demographics
NPI:1942901335
Name:QUEEN, ARTRICE G (LPN)
Entity Type:Individual
Prefix:MISS
First Name:ARTRICE
Middle Name:G
Last Name:QUEEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8039 CHALMERS AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-2305
Mailing Address - Country:US
Mailing Address - Phone:313-483-2101
Mailing Address - Fax:
Practice Address - Street 1:8039 CHALMERS AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2305
Practice Address - Country:US
Practice Address - Phone:313-483-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703127222164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA
NAOtherCASH