Provider Demographics
NPI:1457986465
Name:MCNEIL, MANDY LEE (LP6002170)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:LEE
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:LP6002170
Other - Prefix:MRS
Other - First Name:MANDY
Other - Middle Name:LEE
Other - Last Name:MCNEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LP6002170
Mailing Address - Street 1:22026 20TH AVE SE STE 101
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-4449
Mailing Address - Country:US
Mailing Address - Phone:425-627-7293
Mailing Address - Fax:425-329-4640
Practice Address - Street 1:22026 20TH AVE SE STE 101
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4449
Practice Address - Country:US
Practice Address - Phone:425-627-7293
Practice Address - Fax:425-329-4640
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP6002170164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse