Provider Demographics
NPI:1023762309
Name:MCNEALY, MEAGAN MARIAH (LPN)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:MARIAH
Last Name:MCNEALY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:
Other - Last Name:STOCKETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:304 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:62095-2266
Mailing Address - Country:US
Mailing Address - Phone:618-258-7645
Mailing Address - Fax:
Practice Address - Street 1:304 WESLEY DR
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-2266
Practice Address - Country:US
Practice Address - Phone:618-258-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043127439164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse