Healthcare Provider Details

I. General information

NPI: 1053445635
Provider Name (Legal Business Name): JOANN E MCNEAL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SUNNYBROOK RD
RALEIGH NC
27610-1808
US

IV. Provider business mailing address

178 LIVE OAK CHURCH RD
SELMA NC
27576-6453
US

V. Phone/Fax

Practice location:
  • Phone: 919-250-4700
  • Fax:
Mailing address:
  • Phone: 919-202-5773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-00807
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: