Provider Demographics
NPI:1083246987
Name:QUEEN, JOAN LASAUNDRA
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:LASAUNDRA
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 1:11080 WEYMOUTH CT APT 226
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4592
Mailing Address - Country:US
Mailing Address - Phone:240-346-7784
Mailing Address - Fax:
Practice Address - Street 1:2234 12TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4404
Practice Address - Country:US
Practice Address - Phone:202-667-4109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion