MEDICARE: KATHLEEN MARY O'NEILL PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA10004305	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518914811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MARY O'NEILL PAC

Provider Business Mailing Address
First Line	:	1400 E KINCAID ST
Second Line	:	ATTN: CREDENTIALING
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4127
Country	:	US
Telephone Number	:	360-428-2500
Fax Number	:	360-428-6485

Provider Business Practice Location Address
First Line	:	2320 FREEWAY DR
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-5445
Country	:	US
Telephone Number	:	360-814-6800
Fax Number	:	360-814-6917

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	07/28/2015

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Directions to “ KATHLEEN MARY O'NEILL PAC” Practice Location

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