Healthcare Provider Details

I. General information

NPI: 1639798366
Provider Name (Legal Business Name): ERICA MCNEALEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 07/30/2022
Certification Date: 07/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10571 BARREN SPOT
KINGSHILL VI
00850-9664
US

IV. Provider business mailing address

PO BOX 1421
KINGSHILL VI
00851-1421
US

V. Phone/Fax

Practice location:
  • Phone: 340-692-2510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP14183P
License Number StateVI
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209.021553
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: