Provider Demographics
NPI:1972389922
Name:O'NEILL, AUDREY (MS, PMHNP-BC, RN)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MS, PMHNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DERBY STREET
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-3786
Mailing Address - Country:US
Mailing Address - Phone:781-236-3081
Mailing Address - Fax:
Practice Address - Street 1:1 DERBY STREET
Practice Address - Street 2:SUITE 206
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3786
Practice Address - Country:US
Practice Address - Phone:781-236-3081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2371482163WP0808X
MARN2371482363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health