Provider Demographics
NPI:1982266359
Name:MCNEIL, TAVIA CHARELLE
Entity Type:Individual
Prefix:
First Name:TAVIA
Middle Name:CHARELLE
Last Name:MCNEIL
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 1:411 AIRBRAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMERDING
Mailing Address - State:PA
Mailing Address - Zip Code:15148-1000
Mailing Address - Country:US
Mailing Address - Phone:412-589-3541
Mailing Address - Fax:
Practice Address - Street 1:411 AIRBRAKE AVE
Practice Address - Street 2:
Practice Address - City:WILMERDING
Practice Address - State:PA
Practice Address - Zip Code:15148-1000
Practice Address - Country:US
Practice Address - Phone:412-589-3541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA39323601372500000X, 376J00000X, 372600000X
PA10026492374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker