Provider Demographics
NPI:1184603656
Name:O'NEILL, MEGAN SUZANNE (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:SUZANNE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 UPPER RAGSDALE DR
Mailing Address - Street 2:SUITE B-200
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5736
Mailing Address - Country:US
Mailing Address - Phone:831-375-6334
Mailing Address - Fax:831-375-6331
Practice Address - Street 1:2 UPPER RAGSDALE DR
Practice Address - Street 2:SUITE B-200
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5736
Practice Address - Country:US
Practice Address - Phone:831-375-6334
Practice Address - Fax:831-375-6331
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002580363A00000X
IA001671363A00000X
KS15-01137363A00000X
CAPA21197363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA421060724OtherBILLING TAX ID# FOR CHC
IA421060724B7OtherJOHN DEERE HEALTH
IA109573OtherHEALTH ALLIANCE
IA5100918OtherCONTROLLED SUBSTANCEE #
IA04233OtherIOWA BC/BS IN DAVENPORT
IAIA01B7OtherJOHN DEERE EDI#
IAIA01B7OtherJOHN DEERE EDI#
IA109573OtherHEALTH ALLIANCE
IA421060724B7OtherJOHN DEERE HEALTH