Provider Demographics
NPI:1003083122
Name:NEILL, CARLA MAE
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:MAE
Last Name:NEILL
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 1:10948 N TUZIGOOT DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-7826
Mailing Address - Country:US
Mailing Address - Phone:602-510-0337
Mailing Address - Fax:
Practice Address - Street 1:10948 N TUZIGOOT DR
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-7826
Practice Address - Country:US
Practice Address - Phone:602-510-0337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor