Provider Demographics
NPI:1891491759
Name:ONEAL, MARY SUE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUE
Last Name:ONEAL
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 1:322 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4235
Mailing Address - Country:US
Mailing Address - Phone:970-451-2827
Mailing Address - Fax:
Practice Address - Street 1:2350 W 3RD STREET RD
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-1548
Practice Address - Country:US
Practice Address - Phone:970-350-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker