MEDICARE: SANDRA OLIVER-MCNEIL NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	4704145582	MI

General Provider Information

NPI Number	:	1033277132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA OLIVER-MCNEIL NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	6450 FARMINGTON RD STE 200
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4457
Country	:	US
Telephone Number	:	248-788-4278
Fax Number	:	248-788-2001

Provider Business Practice Location Address
First Line	:	6450 FARMINGTON RD STE 200
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4457
Country	:	US
Telephone Number	:	248-788-4278
Fax Number	:	248-788-2001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/09/2007

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