Provider Demographics
NPI:1306991690
Name:MCQUEEN, MESHA N (PA-C, MMS)
Entity type:Individual
Prefix:MS
First Name:MESHA
Middle Name:N
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:PA-C, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10432 S TORRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-5756
Mailing Address - Country:US
Mailing Address - Phone:773-459-6253
Mailing Address - Fax:773-768-4161
Practice Address - Street 1:10432 S TORRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-5756
Practice Address - Country:US
Practice Address - Phone:773-459-6253
Practice Address - Fax:773-768-4161
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical