Doctor Name: | JENNY O'NEILL |
NPI Number: | 1003265380 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | 20170 |
Business Practice Address: | 200 Arbor Lake Dr Suite 120 Columbia, SC - 292234516 |
Business Phone Number: | 8034578125 |
Business Fax Number: | 8034578129 |
Mailing Address: | 200 Arbor Lake Dr, Suite 120 COLUMBIA |
State: | SC |
Postal Code: | 292234516 |
Phone Number: | 8034578125 |
Fax Number: | 8034578129 |
NPI Enumeration Date: | 06/08/2016 |
NPI Last Update Date: | 06/08/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 20170 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |