Provider Demographics
NPI:1417996307
Name:BROTHERS MCNEIL, TAMARA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:ANN
Last Name:BROTHERS MCNEIL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3122 E MERIDIAN PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7255
Mailing Address - Country:US
Mailing Address - Phone:907-864-4625
Mailing Address - Fax:907-313-1540
Practice Address - Street 1:501 1ST STREET
Practice Address - Street 2:
Practice Address - City:PRUDHOE BAY
Practice Address - State:AK
Practice Address - Zip Code:99734
Practice Address - Country:US
Practice Address - Phone:907-685-1725
Practice Address - Fax:907-357-9593
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK662208VP0014X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1573260Medicaid
AK1573260Medicaid
AKK160458Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE