Provider Demographics
NPI:1801573308
Name:QUEEN, VERNA (RMP)
Entity type:Individual
Prefix:
First Name:VERNA
Middle Name:
Last Name:QUEEN
Suffix:
Gender:F
Credentials:RMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 CEDAR BARN WAY
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1246
Mailing Address - Country:US
Mailing Address - Phone:443-804-8110
Mailing Address - Fax:
Practice Address - Street 1:8415 BELLONA LN STE 110
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2015
Practice Address - Country:US
Practice Address - Phone:410-301-4149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR02810225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty