Provider Demographics
NPI:1528241585
Name:O'NEIL, TERI MARIE (MSN,FNP)
Entity type:Individual
Prefix:MRS
First Name:TERI
Middle Name:MARIE
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:MSN,FNP
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:MARIE
Other - Last Name:JEFFERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN,FNP
Mailing Address - Street 1:801 TOLL HOUSE AVE STE H4
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4555
Mailing Address - Country:US
Mailing Address - Phone:301-698-9444
Mailing Address - Fax:301-695-4444
Practice Address - Street 1:801 TOLL HOUSE AVE STE H4
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4555
Practice Address - Country:US
Practice Address - Phone:301-698-9444
Practice Address - Fax:301-695-4444
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR150040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD098149400Medicaid