Healthcare Provider Details

I. General information

NPI: 1457366742
Provider Name (Legal Business Name): BRENDA B MCNEIL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 FLANDERS RD FLANDERS PEDIATRICS
EAST LYME CT
06333-1743
US

IV. Provider business mailing address

305 FLANDERS RD FLANDERS PEDIATRICS
EAST LYME CT
06333-1743
US

V. Phone/Fax

Practice location:
  • Phone: 860-739-0348
  • Fax: 860-739-6779
Mailing address:
  • Phone: 860-739-0348
  • Fax: 860-739-6779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number001057
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: