Provider Demographics
NPI:1033277132
Name:OLIVER-MCNEIL, SANDRA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:OLIVER-MCNEIL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 FARMINGTON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4457
Mailing Address - Country:US
Mailing Address - Phone:248-788-4278
Mailing Address - Fax:248-788-2001
Practice Address - Street 1:6450 FARMINGTON RD STE 200
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4457
Practice Address - Country:US
Practice Address - Phone:248-788-4278
Practice Address - Fax:248-788-2001
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704145582363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N18190Medicare ID - Type UnspecifiedMEDICARE
MI5008665880Medicare UPIN