Healthcare Provider Details

I. General information

NPI: 1770462764
Provider Name (Legal Business Name): STACY MCNEIL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 W BULLARD AVE APT 127
FRESNO CA
93711-1593
US

IV. Provider business mailing address

3555 W BULLARD AVE APT 127
FRESNO CA
93711-1593
US

V. Phone/Fax

Practice location:
  • Phone: 888-651-3854
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: STACY MCNEIL
Title or Position: CEO
Credential:
Phone: 888-651-3854