Healthcare Provider Details

I. General information

NPI: 1952849101
Provider Name (Legal Business Name): LINNAE O'NEIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MAPLE ST
WATERBURY CENTER VT
05677-8292
US

IV. Provider business mailing address

99 MAPLE ST
WATERBURY CENTER VT
05677-8292
US

V. Phone/Fax

Practice location:
  • Phone: 802-503-5049
  • Fax:
Mailing address:
  • Phone: 802-503-5049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number104.0121719
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: