=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891170031
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNDSAY MACNEIL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2015
-----------------------------------------------------
Last Update Date | 07/29/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 VICTORY RD
-----------------------------------------------------
City | DORCHESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02122-3518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-371-3010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46 FARRAR AVE
-----------------------------------------------------
City | HYDE PARK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02136-3202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN283634
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------