Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 2209 | NC |
NPI | 1649309253 |
---|---|
Provider Name | Amelia Jayne O'neill |
First Address | Camp Lejeune, NC 28547-2538 |
Second Address | Morganton, NC 28655-3938 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 26/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0327Q | BCBS (01) | NC |
187863 | MEDCOST (01) | NC |
6000425 | (05) | NC |