1285627760 NPI number — BRINDA ANN O NEILL NP

Table of content: BRINDA ANN O NEILL NP (NPI 1285627760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285627760 NPI number — BRINDA ANN O NEILL NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O NEILL
Provider First Name:
BRINDA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285627760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9522 E SAN SALVADOR DR
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85258-5557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-991-6624
Provider Business Mailing Address Fax Number:
480-991-1649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9522 E SAN SALVADOR DR
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85258-5557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-991-6624
Provider Business Practice Location Address Fax Number:
480-991-1649
Provider Enumeration Date:
08/30/2005

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: 207RC0000X , with the licence number:  RN105685 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 717192 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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