Doctor Name: | BROOKE MCQUEEN |
NPI Number: | 1134592157 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | MA057679 |
Business Practice Address: | 701 Ostrum St Suite 603 Fountain Hill, PA - 180151155 |
Business Phone Number: | 4845263990 |
Business Fax Number: | 6108682915 |
Mailing Address: | 701 Ostrum St, Suite 603 FOUNTAIN HILL |
State: | PA |
Postal Code: | 180151155 |
Phone Number: | 4845263990 |
Fax Number: | 6108682915 |
NPI Enumeration Date: | 11/13/2015 |
NPI Last Update Date: | 11/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | MA057679 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |