Provider Demographics
NPI:1285627760
Name:O NEILL, BRINDA ANN (NP)
Entity Type:Individual
Prefix:
First Name:BRINDA
Middle Name:ANN
Last Name:O NEILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9522 E SAN SALVADOR DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5557
Mailing Address - Country:US
Mailing Address - Phone:480-991-6624
Mailing Address - Fax:480-991-1649
Practice Address - Street 1:9522 E SAN SALVADOR DR
Practice Address - Street 2:SUITE 206
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5557
Practice Address - Country:US
Practice Address - Phone:480-991-6624
Practice Address - Fax:480-991-1649
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN105685207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ717192Medicaid
AZ717192Medicaid
71894Medicare ID - Type Unspecified