Individual
MS. BEVERLY LAVON MCNEIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
530 BOGACHIEL WAY, FORKS, WA 98331-9120
(360) 374-6271
(360) 374-6238
Mailing address
1265 EDDY ST, PORT TOWNSEND, WA 98368-9216
(360) 385-9730
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10004657
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0188321
L&I
WA
01
—
2334MC
REGENCE
WA
05
—
8389975
—
WA
Enumeration date
02/06/2007
Last updated
06/15/2011
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