Healthcare Provider Details

I. General information

NPI: 1982422564
Provider Name (Legal Business Name): MCNALLY MOBILE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5089 SE 1 1/2 AVE
NEW PLYMOUTH ID
83655-5254
US

IV. Provider business mailing address

5089 SE 1 1/2 AVE
NEW PLYMOUTH ID
83655-5254
US

V. Phone/Fax

Practice location:
  • Phone: 986-207-1720
  • Fax: 866-531-4582
Mailing address:
  • Phone: 986-200-6219
  • Fax: 866-531-4582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL MCNALLY
Title or Position: CEO
Credential: NP
Phone: 986-200-6219