Provider Demographics
NPI:1114109998
Name:NEAL, MARY ANN PATRICE (RN, PHN)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:PATRICE
Last Name:NEAL
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6231 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3531
Mailing Address - Country:US
Mailing Address - Phone:530-877-0283
Mailing Address - Fax:
Practice Address - Street 1:6231 LANCASTER DR
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3531
Practice Address - Country:US
Practice Address - Phone:530-877-0283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417379163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse