Provider Demographics
NPI:1619963592
Name:O'NEIL, JOHN J (FNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:O'NEIL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CRANBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3117
Mailing Address - Country:US
Mailing Address - Phone:508-746-7824
Mailing Address - Fax:
Practice Address - Street 1:14 CRANBERRY CIR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3117
Practice Address - Country:US
Practice Address - Phone:508-746-7824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2855OtherBCBS
MANP2855Medicare ID - Type Unspecified
P18273Medicare UPIN