Provider Demographics
NPI:1447537667
Name:DANA-MCQUEEN, KIM E (LCO)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:E
Last Name:DANA-MCQUEEN
Suffix:
Gender:F
Credentials:LCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 COLBY AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4928
Mailing Address - Country:US
Mailing Address - Phone:206-498-3909
Mailing Address - Fax:
Practice Address - Street 1:4009 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4928
Practice Address - Country:US
Practice Address - Phone:206-498-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOI60218712222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist