Provider Demographics
NPI:1629383781
Name:MCNEELY, CHRISTOPHER MATTHEW
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MATTHEW
Last Name:MCNEELY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34860 LAKESHORE BLVD
Mailing Address - Street 2:APT H
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095-2090
Mailing Address - Country:US
Mailing Address - Phone:440-749-6403
Mailing Address - Fax:
Practice Address - Street 1:34860 LAKESHORE BLVD
Practice Address - Street 2:APT H
Practice Address - City:EASTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44095-2090
Practice Address - Country:US
Practice Address - Phone:440-749-6403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.140458-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse