Provider Demographics
NPI:1255039251
Name:MCNEELY, KARLEE
Entity type:Individual
Prefix:
First Name:KARLEE
Middle Name:
Last Name:MCNEELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARLEE
Other - Middle Name:
Other - Last Name:VANDEVELDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:219 COLONIAL CT
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:IL
Mailing Address - Zip Code:62670-4548
Mailing Address - Country:US
Mailing Address - Phone:217-883-2622
Mailing Address - Fax:
Practice Address - Street 1:800 E CARPENTER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62769-1000
Practice Address - Country:US
Practice Address - Phone:217-544-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209029198367500000X
IL041432458163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse