Provider Demographics
NPI:1235297326
Name:MCNEIL, CRYSTAL LYNN
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LYNN
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3992 CHERRY TREE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-8508
Mailing Address - Country:US
Mailing Address - Phone:336-375-1846
Mailing Address - Fax:336-375-1846
Practice Address - Street 1:3992 CHERRY TREE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-8508
Practice Address - Country:US
Practice Address - Phone:336-375-1846
Practice Address - Fax:336-375-1846
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3417374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601513Medicaid