Healthcare Provider Details

I. General information

NPI: 1962414722
Provider Name (Legal Business Name): ERICA O'NEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 11051
YELLOWKNIFE NT
X1A 0E3
CA

IV. Provider business mailing address

PO BOX 11051
YELLOWKNIFE NT
X1A 0E3
CA

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number042-0011044
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: