| NPI | 1235567975 |
|---|---|
| Former Name | MAVIS ELIZABETH MACNEIL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 5571) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F337730) |
| 363LF0000X Nurse Practitioner, Family (Licence: RI APRN00475) | |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2016-12-03 |