Provider Demographics
NPI:1578983938
Name:MCGILL, SEANEATHER ARLINE
Entity Type:Individual
Prefix:
First Name:SEANEATHER
Middle Name:ARLINE
Last Name:MCGILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SEANEATHER
Other - Middle Name:ARLINE
Other - Last Name:LOUGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2024 SHADY LANE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204
Mailing Address - Country:US
Mailing Address - Phone:601-335-8031
Mailing Address - Fax:844-504-3094
Practice Address - Street 1:2024 SHADY LANE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204
Practice Address - Country:US
Practice Address - Phone:601-335-8031
Practice Address - Fax:844-504-3094
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA051647376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide