Provider Demographics
NPI:1093062275
Name:MCGILL, AIMEE SUSANNE (CNA, RMA, MH, DOULA)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:SUSANNE
Last Name:MCGILL
Suffix:
Gender:F
Credentials:CNA, RMA, MH, DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W NONNAMAKER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-7140
Mailing Address - Country:US
Mailing Address - Phone:479-502-2491
Mailing Address - Fax:
Practice Address - Street 1:304 W NONNAMAKER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-7140
Practice Address - Country:US
Practice Address - Phone:479-502-2491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
114234568374J00000X
AR050377550911E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374J00000XNursing Service Related ProvidersDoula