Healthcare Provider Details

I. General information

NPI: 1316918550
Provider Name (Legal Business Name): STEVEN ANTHONY MCNEILL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HQ, US ARMY MEDDAC
FORT WAINWRIGHT AK
99703-7400
US

IV. Provider business mailing address

5784 TENDERFOOT CT
SALCHA AK
99714-9700
US

V. Phone/Fax

Practice location:
  • Phone: 907-353-5144
  • Fax:
Mailing address:
  • Phone: 907-488-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number233888
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: