Provider Demographics
NPI:1265633978
Name:MCNEELY, ANDREA JULEEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:JULEEN
Last Name:MCNEELY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30364 LANGE LN
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENT
Mailing Address - State:MN
Mailing Address - Zip Code:55947-4225
Mailing Address - Country:US
Mailing Address - Phone:414-659-5580
Mailing Address - Fax:
Practice Address - Street 1:306 W MCMILLAN ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-6013
Practice Address - Country:US
Practice Address - Phone:715-387-1702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program