Healthcare Provider Details

I. General information

NPI: 1386309623
Provider Name (Legal Business Name): CARRIE CHRISTINE MCNEELY-SCHENONE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S MAIN ST
YREKA CA
96097-3354
US

IV. Provider business mailing address

PO BOX 838
ETNA CA
96027-0838
US

V. Phone/Fax

Practice location:
  • Phone: 530-842-3507
  • Fax:
Mailing address:
  • Phone: 530-604-6135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95019010
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: