Provider Demographics
NPI:1013115583
Name:QUEEN, DENNIS (RN)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:QUEEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E 15TH ST
Mailing Address - Street 2:MERCED CO. PUBLIC HEALTH
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0112
Mailing Address - Country:US
Mailing Address - Phone:209-381-1204
Mailing Address - Fax:209-381-1173
Practice Address - Street 1:260 E 15TH ST
Practice Address - Street 2:MERCED CO. PUBLIC HEALTH
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0112
Practice Address - Country:US
Practice Address - Phone:209-381-1204
Practice Address - Fax:209-381-1173
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN525119163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA163WC1500XMedicare UPIN