Provider Demographics
NPI:1679604813
Name:MCNEILL, CHARLOTTE CLARK (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:CLARK
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 S LONG DR
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-4315
Mailing Address - Country:US
Mailing Address - Phone:910-997-7180
Mailing Address - Fax:910-997-3830
Practice Address - Street 1:711 S LONG DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4315
Practice Address - Country:US
Practice Address - Phone:910-997-7180
Practice Address - Fax:910-997-3830
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC121478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004394Medicaid