Provider Demographics
NPI:1427083476
Name:MCNEIL, ANN LOUISE (NP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:LOUISE
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6917
Mailing Address - Country:US
Mailing Address - Phone:805-739-3474
Mailing Address - Fax:
Practice Address - Street 1:2 JAMES WAY
Practice Address - Street 2:SUITE 209
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-4976
Practice Address - Country:US
Practice Address - Phone:805-773-7440
Practice Address - Fax:805-773-7448
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8442363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB244032OtherMEDICARE ID
CA8442OtherNP FURNISHING LICENSE #
CAW17371Medicare PIN