Provider Demographics
NPI:1427681493
Name:O'NEIL, DENISE ANN (AGNP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ANN
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 HUNGRY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:GREAT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14741-9776
Mailing Address - Country:US
Mailing Address - Phone:716-560-6068
Mailing Address - Fax:
Practice Address - Street 1:4039 US 219
Practice Address - Street 2:
Practice Address - City:SALAMANCA
Practice Address - State:NY
Practice Address - Zip Code:14779
Practice Address - Country:US
Practice Address - Phone:716-945-0371
Practice Address - Fax:716-945-0361
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309565363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health