Provider Demographics
NPI:1700226313
Name:O'NEILL, JANINE MARIE (FNP - BC)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:MARIE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:FNP - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19313 MIDDLE BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-6704
Mailing Address - Country:US
Mailing Address - Phone:586-747-9779
Mailing Address - Fax:
Practice Address - Street 1:43900 GARFIELD RD STE 222
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1137
Practice Address - Country:US
Practice Address - Phone:586-286-0500
Practice Address - Fax:586-286-0880
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704258954363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily