Provider Demographics
NPI:1255804035
Name:QUE, MARIA AILEEN (FNP)
Entity type:Individual
Prefix:
First Name:MARIA AILEEN
Middle Name:
Last Name:QUE
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 1:8049 LAUREL CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-1428
Mailing Address - Country:US
Mailing Address - Phone:818-203-9219
Mailing Address - Fax:
Practice Address - Street 1:18350 ROSCOE BLVD STE 303
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4157
Practice Address - Country:US
Practice Address - Phone:818-203-9219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty