Provider Demographics
NPI:1720272750
Name:MACNEILL, MELISSA LYNN
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LYNN
Last Name:MACNEILL
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 1:1901 SOLAR DR
Mailing Address - Street 2:STE 265
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0633
Mailing Address - Country:US
Mailing Address - Phone:805-746-4669
Mailing Address - Fax:805-830-1120
Practice Address - Street 1:1901 SOLAR DR STE 265
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0633
Practice Address - Country:US
Practice Address - Phone:805-746-4669
Practice Address - Fax:805-830-1120
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily