Provider Demographics
NPI:1427704295
Name:MCNELLY, DESTINY
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:MCNELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23114 WELLINGTON CRES APT 304
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3556
Mailing Address - Country:US
Mailing Address - Phone:586-627-4396
Mailing Address - Fax:
Practice Address - Street 1:23114 WELLINGTON CRES APT 304
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-3556
Practice Address - Country:US
Practice Address - Phone:586-627-4396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide