Provider Demographics
NPI:1275328304
Name:NEIL, PAUL MICHAEL (RN)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:NEIL
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E GURLEY ST # 274
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-3804
Mailing Address - Country:US
Mailing Address - Phone:928-550-6705
Mailing Address - Fax:
Practice Address - Street 1:3613 CROSSINGS DR STE B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7189
Practice Address - Country:US
Practice Address - Phone:928-550-6705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ174758163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult