Provider Demographics
NPI:1629152210
Name:ONEILL, AMY NICHOLS (DOM)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:NICHOLS
Last Name:ONEILL
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W PALMER RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2049
Mailing Address - Country:US
Mailing Address - Phone:505-527-0821
Mailing Address - Fax:505-524-2059
Practice Address - Street 1:200 W LAS CRUCES AVE
Practice Address - Street 2:SUITE E
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2049
Practice Address - Country:US
Practice Address - Phone:505-496-8161
Practice Address - Fax:505-524-2059
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM792171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00RJ29OtherBLUE CROSS BLUE SHIELD