Healthcare Provider Details

I. General information

NPI: 1184548257
Provider Name (Legal Business Name): HELENE MCNEILL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 ROOSEVELT AVE
GRANTS NM
87020
US

IV. Provider business mailing address

PO BOX 8
GRANTS NM
87020-0008
US

V. Phone/Fax

Practice location:
  • Phone: 505-285-2600
  • Fax:
Mailing address:
  • Phone: 505-285-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number59572
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: