Provider Demographics
NPI:1871844555
Name:NEAL, WILLIE J
Entity Type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:J
Last Name:NEAL
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 1:876 KINWEST PKWY
Mailing Address - Street 2:APT 13
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-8591
Mailing Address - Country:US
Mailing Address - Phone:682-777-6520
Mailing Address - Fax:
Practice Address - Street 1:876 KINWEST PKWY
Practice Address - Street 2:APT 13
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-8591
Practice Address - Country:US
Practice Address - Phone:682-777-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion