Provider Demographics
NPI:1831161124
Name:ONEILL, TIMOTHY MICHAEL (PA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:ONEILL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 LUCERNE ST
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-4369
Mailing Address - Country:US
Mailing Address - Phone:775-782-1603
Mailing Address - Fax:775-782-3417
Practice Address - Street 1:1649 LUCERNE ST
Practice Address - Street 2:SUITE A & B
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4369
Practice Address - Country:US
Practice Address - Phone:775-782-1603
Practice Address - Fax:775-782-3417
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA718363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q59582Medicare UPIN
NV101819Medicare PIN
NV293985Medicare PIN
NVV105758Medicare PIN