Provider Demographics
NPI:1689937187
Name:NEVILLE, MAUREEN ANN
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANN
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 KEESLER RD
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:PA
Mailing Address - Zip Code:18415-3588
Mailing Address - Country:US
Mailing Address - Phone:570-224-6830
Mailing Address - Fax:
Practice Address - Street 1:156 KEESLER RD
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:PA
Practice Address - Zip Code:18415-3588
Practice Address - Country:US
Practice Address - Phone:570-224-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist