Healthcare Provider Details

I. General information

NPI: 1689493819
Provider Name (Legal Business Name): MANESHIA O'NEAL REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4859 SADDLEHORN CV
MEMPHIS TN
38125-3687
US

IV. Provider business mailing address

3735 HICKORY HILL RD UNIT 750001
MEMPHIS TN
38175-0013
US

V. Phone/Fax

Practice location:
  • Phone: 901-321-0682
  • Fax:
Mailing address:
  • Phone: 901-321-0682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number195972
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number195972
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number195972
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: