Healthcare Provider Details

I. General information

NPI: 1831161124
Provider Name (Legal Business Name): TIMOTHY MICHAEL ONEILL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1649 LUCERNE ST SUITE A & B
MINDEN NV
89423-4369
US

IV. Provider business mailing address

1649 LUCERNE ST SUITE A & B
MINDEN NV
89423-4369
US

V. Phone/Fax

Practice location:
  • Phone: 775-782-1603
  • Fax: 775-782-3417
Mailing address:
  • Phone: 775-782-1603
  • Fax: 775-782-3417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA718
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: