Provider Demographics
NPI:1043007784
Name:MCNEILL, LYDIA
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:MCNEILL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407A W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-9537
Mailing Address - Country:US
Mailing Address - Phone:910-690-4211
Mailing Address - Fax:
Practice Address - Street 1:407A W 5TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-9537
Practice Address - Country:US
Practice Address - Phone:910-690-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker