Provider Demographics
NPI:1124769906
Name:MACNEILL, STEPHANIE (RD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MACNEILL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3174 LAVERNE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-5283
Mailing Address - Country:US
Mailing Address - Phone:562-896-2790
Mailing Address - Fax:
Practice Address - Street 1:3174 LAVERNE AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-5283
Practice Address - Country:US
Practice Address - Phone:562-896-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered