Healthcare Provider Details

I. General information

NPI: 1760194815
Provider Name (Legal Business Name): MICHAEL MCNEIL FNP-C, PMHNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 E VINE ST STE 14
MURRAY UT
84107-5541
US

IV. Provider business mailing address

688 E VINE ST STE 14
MURRAY UT
84107-5541
US

V. Phone/Fax

Practice location:
  • Phone: 801-436-6556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number106685054405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: