Provider Demographics
NPI:1982335162
Name:QUEEN, GAIL NICOLE
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:NICOLE
Last Name:QUEEN
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 1:202 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43532-9337
Mailing Address - Country:US
Mailing Address - Phone:740-751-1711
Mailing Address - Fax:
Practice Address - Street 1:202 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:LIBERTY CENTER
Practice Address - State:OH
Practice Address - Zip Code:43532-9337
Practice Address - Country:US
Practice Address - Phone:740-751-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide