Provider Demographics
NPI:1952316465
Name:MCQUEEN, CRISTIN EILEEN (FNP)
Entity Type:Individual
Prefix:
First Name:CRISTIN
Middle Name:EILEEN
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 SE 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-3427
Mailing Address - Country:US
Mailing Address - Phone:503-762-0971
Mailing Address - Fax:
Practice Address - Street 1:5222 SE 109TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-3427
Practice Address - Country:US
Practice Address - Phone:503-762-0971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR097006861RN363LF0000X
OR200350111NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR277856Medicaid