Provider Demographics
NPI:1225585458
Name:O'NEAL, MARTY (CNA)
Entity Type:Individual
Prefix:MRS
First Name:MARTY
Middle Name:
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 COCONUT LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4432
Mailing Address - Country:US
Mailing Address - Phone:757-646-1803
Mailing Address - Fax:
Practice Address - Street 1:404 COCONUT LN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4432
Practice Address - Country:US
Practice Address - Phone:757-646-1803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401153404376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide