Individual
KENNETH L MCNEELY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
580 W COLLEGE AVE, MARQUETTE, MI 49855-2705
(906) 225-3406
(906) 225-3094
Mailing address
37 OAK HILL DR, MARQUETTE, MI 49855-9446
(906) 225-0562
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704107823
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43400900
WISC MEDICAID PIN
WI
01
—
KM107823
BLUESHIELD PIN
MI
Enumeration date
11/15/2005
Last updated
07/09/2007
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