Provider Demographics
NPI:1790179984
Name:MCQUEEN, NATALIE KATHRYN (PA-C)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:KATHRYN
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 ROHNERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-3118
Mailing Address - Country:US
Mailing Address - Phone:707-725-4477
Mailing Address - Fax:
Practice Address - Street 1:3750 ROHNERVILLE RD
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-3118
Practice Address - Country:US
Practice Address - Phone:707-725-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2733363A00000X, 363AM0700X
CA61051363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant