Provider Demographics
NPI:1386676161
Name:MCNEILL, MARY (CDE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6957 W PLANO PKWY STE 2700
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-1626
Mailing Address - Country:US
Mailing Address - Phone:214-808-3427
Mailing Address - Fax:
Practice Address - Street 1:6957 W PLANO PKWY STE 2700
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-1626
Practice Address - Country:US
Practice Address - Phone:214-808-3427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06756133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2346Medicare ID - Type Unspecified
TXTXB113554Medicare PIN
TX8D2387Medicare ID - Type Unspecified
TXC19231Medicare UPIN
TX8L14645Medicare PIN
TX8F2177Medicare ID - Type Unspecified
TX8L14755Medicare PIN
TN8L14756Medicare PIN