Healthcare Provider Details

I. General information

NPI: 1952526162
Provider Name (Legal Business Name): MCNEIL-JORDAN ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5412 HADRIAN DR
DURHAM NC
27703-7120
US

IV. Provider business mailing address

5412 HADRIAN DR
DURHAM NC
27703-7120
US

V. Phone/Fax

Practice location:
  • Phone: 919-638-5485
  • Fax:
Mailing address:
  • Phone: 919-638-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License NumberL000736
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberL000736
License Number StateNC

VIII. Authorized Official

Name: MS. DONNA Y MCNEIL
Title or Position: CEO
Credential: MPH,RD,LDN
Phone: 919-638-5485