Provider Demographics
NPI:1558061952
Name:O'NEILL, JEANNA
Entity Type:Individual
Prefix:
First Name:JEANNA
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 COUNTY ROAD 1121
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:42021-8544
Mailing Address - Country:US
Mailing Address - Phone:618-944-3354
Mailing Address - Fax:
Practice Address - Street 1:574 COUNTY ROAD 1121
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:KY
Practice Address - Zip Code:42021-8544
Practice Address - Country:US
Practice Address - Phone:618-944-3354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1065649163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse