Provider Demographics
NPI:1568866572
Name:NEELEY, MARIA (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:NEELEY
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4042 ALABASTER ST SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-2184
Mailing Address - Country:US
Mailing Address - Phone:253-414-3981
Mailing Address - Fax:
Practice Address - Street 1:4042 ALABASTER ST SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2184
Practice Address - Country:US
Practice Address - Phone:253-414-3981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60443204163W00000X
WAAP61583868363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse