Provider Demographics
NPI:1356717680
Name:MCQUEEN, CATHERINE
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 JUAN TABO BLVD NE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2681
Mailing Address - Country:US
Mailing Address - Phone:505-332-8070
Mailing Address - Fax:505-275-6678
Practice Address - Street 1:4425 JUAN TABO BLVD NE
Practice Address - Street 2:SUITE 140
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2681
Practice Address - Country:US
Practice Address - Phone:505-332-8070
Practice Address - Fax:505-275-6678
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-1024133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered