MEDICARE: HEATHER O'NEAL

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	164W00000X	Licensed Practical Nurse	PN123664	OH

General Provider Information

NPI Number	:	1720678220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER O'NEAL

Provider Business Mailing Address
First Line	:	4495 FOREST TRL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-1547
Country	:	US
Telephone Number	:	513-646-4640
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 BEECHWOOD RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-1809
Country	:	US
Telephone Number	:	513-943-3680
Fax Number	:

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

Provider Enumeration Date	:	01/19/2021
Last Update Date	:	01/19/2021

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Directions to “ HEATHER O'NEAL ” Practice Location

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