Provider Demographics
NPI:1184850372
Name:MCNALLY, EDMUND (PA)
Entity Type:Individual
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First Name:EDMUND
Middle Name:
Last Name:MCNALLY
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Gender:M
Credentials:PA
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Mailing Address - Street 1:4801 N BUTLER AVE
Mailing Address - Street 2:STE 8102
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6002
Mailing Address - Country:US
Mailing Address - Phone:505-436-2671
Mailing Address - Fax:505-436-2673
Practice Address - Street 1:4801 N BUTLER AVE
Practice Address - Street 2:STE 8102
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6002
Practice Address - Country:US
Practice Address - Phone:505-436-2671
Practice Address - Fax:505-436-2673
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2016-02-08
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Provider Licenses
StateLicense IDTaxonomies
NM91-PA04363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant