Healthcare Provider Details

I. General information

NPI: 1649398553
Provider Name (Legal Business Name): MISTY JO NEAL LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 TUSCARAWAS AVE
NEWCOMERSTOWN OH
43832
US

IV. Provider business mailing address

220 SPAULDING AVE
NEWCOMERSTOWN OH
43832
US

V. Phone/Fax

Practice location:
  • Phone: 740-498-7254
  • Fax:
Mailing address:
  • Phone: 740-498-4410
  • Fax: 740-498-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN 101520
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: