Provider Demographics
NPI:1942527130
Name:MCNICOL, MARY ANN Q (RPT)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:Q
Last Name:MCNICOL
Suffix:
Gender:F
Credentials:RPT
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Mailing Address - Street 1:6405 NIGHTINGALE ST
Mailing Address - Street 2:#102
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7912
Mailing Address - Country:US
Mailing Address - Phone:805-444-8468
Mailing Address - Fax:805-620-0663
Practice Address - Street 1:6405 NIGHTINGALE ST
Practice Address - Street 2:#102
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7912
Practice Address - Country:US
Practice Address - Phone:805-444-8468
Practice Address - Fax:805-620-0663
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CACPT40230246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy