Provider Demographics
NPI:1316027428
Name:MCNEILL, NINA GALIA (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:GALIA
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16929 E HINSDALE WAY
Mailing Address - Street 2:
Mailing Address - City:FOXFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1695
Mailing Address - Country:US
Mailing Address - Phone:303-690-1547
Mailing Address - Fax:
Practice Address - Street 1:4675 E 69TH AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-2343
Practice Address - Country:US
Practice Address - Phone:303-853-5411
Practice Address - Fax:303-853-5484
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72822363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics