Provider Demographics
NPI:1104500479
Name:MCNEACE, HALIE
Entity type:Individual
Prefix:
First Name:HALIE
Middle Name:
Last Name:MCNEACE
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 1:475 NAVAJO LN W
Mailing Address - Street 2:
Mailing Address - City:LAKE QUIVIRA
Mailing Address - State:KS
Mailing Address - Zip Code:66217-8693
Mailing Address - Country:US
Mailing Address - Phone:816-898-3665
Mailing Address - Fax:
Practice Address - Street 1:475 NAVAJO LN W
Practice Address - Street 2:
Practice Address - City:LAKE QUIVIRA
Practice Address - State:KS
Practice Address - Zip Code:66217-8693
Practice Address - Country:US
Practice Address - Phone:816-898-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSTMP-161781367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered