Provider Demographics
NPI:1730514381
Name:NKEH, QUEENDROLINE
Entity type:Individual
Prefix:
First Name:QUEENDROLINE
Middle Name:
Last Name:NKEH
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 1:1995 WINDING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-6444
Mailing Address - Country:US
Mailing Address - Phone:240-486-8941
Mailing Address - Fax:
Practice Address - Street 1:265 FRANKLIN ST STE 1702
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-3144
Practice Address - Country:US
Practice Address - Phone:240-486-8941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0101297-C-NP363LP0808X
MARN2375954363LP0808X
IAG171992363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty