Provider Demographics
NPI:1548393804
Name:ONEAL, MARY JO (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JO
Last Name:ONEAL
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Gender:F
Credentials:FNP
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Mailing Address - Street 1:3714 GUARDIAN AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2974
Mailing Address - Country:US
Mailing Address - Phone:252-247-2101
Mailing Address - Fax:252-247-4675
Practice Address - Street 1:3714 GUARDIAN AVE
Practice Address - Street 2:SUITE E
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2974
Practice Address - Country:US
Practice Address - Phone:252-247-2101
Practice Address - Fax:252-247-4675
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2014-02-05
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Provider Licenses
StateLicense IDTaxonomies
NC005003030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004006Medicaid
NC2592907Medicare PIN