Provider Demographics
NPI:1255393831
Name:MCNEIL, ALISON L (PA)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:L
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:L
Other - Last Name:SHIMINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PROVIDER ENROLLMENT
Mailing Address - Street 2:100 KIMEL FOREST DRIVE
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-713-0947
Mailing Address - Fax:
Practice Address - Street 1:1188 YADKINVILLE RD
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2037
Practice Address - Country:US
Practice Address - Phone:336-716-7435
Practice Address - Fax:336-702-9277
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103073363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2752945Medicare ID - Type Unspecified
P13909Medicare UPIN