Provider Demographics
NPI:1295349991
Name:ONEIL, JESSE L
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:L
Last Name:ONEIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 EVANS LN
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-5601
Mailing Address - Country:US
Mailing Address - Phone:301-707-4569
Mailing Address - Fax:
Practice Address - Street 1:366 EVANS LN
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-5601
Practice Address - Country:US
Practice Address - Phone:301-707-4569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator