Provider Demographics
NPI:1639642416
Name:QUEEN, ELIZABETH (CNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:QUEEN
Suffix:
Gender:
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 SCIOTO MEADOWS BLVD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8654
Mailing Address - Country:US
Mailing Address - Phone:614-204-4721
Mailing Address - Fax:
Practice Address - Street 1:2260 MORSE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5858
Practice Address - Country:US
Practice Address - Phone:614-702-7899
Practice Address - Fax:614-706-1570
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.407599363LF0000X
OHAPRN.CNP.024127363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily