Provider Demographics
NPI:1073872354
Name:O'NEILL, BRIAN P (APRN)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 ROAD 7
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-8545
Mailing Address - Country:US
Mailing Address - Phone:307-754-9196
Mailing Address - Fax:
Practice Address - Street 1:1134 ROAD 7
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-8545
Practice Address - Country:US
Practice Address - Phone:307-754-9196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY23848163W00000X
WY23848.1193363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse