Provider Demographics
NPI:1336208701
Name:MACNEIL, DOUGLAS G (FNP)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:G
Last Name:MACNEIL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:MR
Other - First Name:DOUGLAS
Other - Middle Name:G
Other - Last Name:MAC NEIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:129 KIMBALL RD
Mailing Address - Street 2:
Mailing Address - City:RINDGE
Mailing Address - State:NH
Mailing Address - Zip Code:03461-5010
Mailing Address - Country:US
Mailing Address - Phone:603-899-5684
Mailing Address - Fax:
Practice Address - Street 1:580 COURT ST # 590
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1718
Practice Address - Country:US
Practice Address - Phone:603-354-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH054569-23-03363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care