Provider Demographics
NPI:1598805079
Name:O NEIL, MARYBETH L (CNS)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:L
Last Name:O NEIL
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:MARYBETH
Other - Middle Name:L
Other - Last Name:PARTINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS
Mailing Address - Street 1:2100 CAMPUS DR SE
Mailing Address - Street 2:ROCHESTER
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-4831
Mailing Address - Country:US
Mailing Address - Phone:507-259-5329
Mailing Address - Fax:
Practice Address - Street 1:2100 CAMPUS DR SE
Practice Address - Street 2:ROCHESTER
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4831
Practice Address - Country:US
Practice Address - Phone:507-259-5329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 097255-2364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN163405400Medicaid
MN890000099Medicare PIN
MN890000525Medicare PIN
MNP03981Medicare UPIN
MN163405400Medicaid