Provider Demographics
NPI:1558994426
Name:MCNEIL, NEDRA NICOLE (LPN)
Entity Type:Individual
Prefix:MS
First Name:NEDRA
Middle Name:NICOLE
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 MASON ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-6107
Mailing Address - Country:US
Mailing Address - Phone:347-869-9524
Mailing Address - Fax:
Practice Address - Street 1:245 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5516
Practice Address - Country:US
Practice Address - Phone:212-683-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331415-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse