=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619450889
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JILLIAN LEE MCNEIL RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2018
-----------------------------------------------------
Last Update Date | 06/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 95 TREMONT ST STE 2
-----------------------------------------------------
City | DUXBURY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02332-4738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-803-7757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 HOLIDAY LN
-----------------------------------------------------
City | SANDWICH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02563-2588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-564-2239
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | RN2279603
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------