Provider Demographics
NPI:1982749123
Name:QUEEN, EJEANEE D (RN, FNP)
Entity Type:Individual
Prefix:MS
First Name:EJEANEE
Middle Name:D
Last Name:QUEEN
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1000 E PLEASANT RUN RD
Mailing Address - Street 2:#4633
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-5513
Mailing Address - Country:US
Mailing Address - Phone:214-421-7848
Mailing Address - Fax:214-421-1119
Practice Address - Street 1:1906 PEABODY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-2821
Practice Address - Country:US
Practice Address - Phone:214-421-7848
Practice Address - Fax:214-421-1119
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX735724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily