Provider Demographics
NPI:1124416284
Name:MCNALLY, VICKI L (NP)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:L
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:VICKI
Other - Middle Name:L
Other - Last Name:SPEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:130 TOWN CENTER DR
Mailing Address - Street 2:203
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1744
Mailing Address - Country:US
Mailing Address - Phone:248-585-8250
Mailing Address - Fax:248-585-8270
Practice Address - Street 1:3601 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-898-4021
Practice Address - Fax:248-898-1473
Is Sole Proprietor?:No
Enumeration Date:2014-12-24
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704279535363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner