Provider Demographics
NPI:1962718205
Name:O'NEILL, KEIRA RENE' (LPN)
Entity type:Individual
Prefix:
First Name:KEIRA
Middle Name:RENE'
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1478
Mailing Address - Country:US
Mailing Address - Phone:614-264-6425
Mailing Address - Fax:
Practice Address - Street 1:1142 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-1478
Practice Address - Country:US
Practice Address - Phone:614-264-6425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.139265-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse