Provider Demographics
NPI:1851652168
Name:MCNEILL, SANDRA ELDER (APN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELDER
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 SAINT JOHN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2209
Mailing Address - Country:US
Mailing Address - Phone:731-285-6110
Mailing Address - Fax:731-285-6964
Practice Address - Street 1:2017 SAINT JOHN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2209
Practice Address - Country:US
Practice Address - Phone:731-285-6110
Practice Address - Fax:731-285-6964
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily