Provider Demographics
NPI:1174005854
Name:NEILL, CAROLINE MICHELLE (CNM)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MICHELLE
Last Name:NEILL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:MICHELLE
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:78 PARK VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2464
Mailing Address - Country:US
Mailing Address - Phone:336-687-7279
Mailing Address - Fax:
Practice Address - Street 1:930 3RD ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6967
Practice Address - Country:US
Practice Address - Phone:336-890-3200
Practice Address - Fax:336-890-3290
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC701176B00000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife