Provider Demographics
NPI:1144779067
Name:MCNEIL, MYRTO (CRNP, DNP)
Entity Type:Individual
Prefix:
First Name:MYRTO
Middle Name:
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:CRNP, DNP
Other - Prefix:
Other - First Name:MYRTO
Other - Middle Name:
Other - Last Name:TELISMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:550 MAIN STREET, SUITE 250
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:612-326-7575
Mailing Address - Fax:612-454-2430
Practice Address - Street 1:135 COLORADO STREET EAST
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107
Practice Address - Country:US
Practice Address - Phone:651-489-7740
Practice Address - Fax:651-489-6458
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016614363LP0808X
MN7418363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health