1144779067 NPI number — MYRTO MCNEIL CRNP, DNP

Table of content: MYRTO MCNEIL CRNP, DNP (NPI 1144779067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144779067 NPI number — MYRTO MCNEIL CRNP, DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNEIL
Provider First Name:
MYRTO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP, DNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TELISMA
Provider Other First Name:
MYRTO
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144779067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 MAIN STREET, SUITE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRIGHTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-326-7575
Provider Business Mailing Address Fax Number:
612-454-2430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 COLORADO STREET EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-489-7740
Provider Business Practice Location Address Fax Number:
651-489-6458
Provider Enumeration Date:
10/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  SP016614 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 7418 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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