Provider Demographics
NPI:1063958577
Name:MCNEILL, AMANDA CIERRA (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CIERRA
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-3039
Mailing Address - Country:US
Mailing Address - Phone:910-875-4545
Mailing Address - Fax:910-875-8972
Practice Address - Street 1:1090 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3039
Practice Address - Country:US
Practice Address - Phone:910-875-4545
Practice Address - Fax:910-875-8972
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06953363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant