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General NPI Number Information
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NPI Number | 1194173112
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Entity Type | Organization
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Legal Business Name | O'NEILL MEDICAL GROUP, P.C.
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 11177 N ORACLE RD APT 10302
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City | TUCSON
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State | AZ
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Zip | 85737-5651
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Country | US
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Telephone | 520-301-1603
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Fax |
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Provider Business Mailing Address
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Address Line | 11177 N ORACLE RD APT 10302
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City | TUCSON
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State | AZ
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Zip | 85737-5651
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Country | US
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Telephone | 520-301-1603
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GLORIA O'NEILL
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Credential |
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Telephone | 520-301-1603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP-8354
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License Number State | AZ
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