Provider Demographics
NPI:1689493819
Name:O'NEAL, MANESHIA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:MANESHIA
Middle Name:
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 HICKORY HILL RD UNIT 750001
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38175-0013
Mailing Address - Country:US
Mailing Address - Phone:901-321-0682
Mailing Address - Fax:
Practice Address - Street 1:4859 SADDLEHORN CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-3687
Practice Address - Country:US
Practice Address - Phone:901-321-0682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN195972163WH0200X, 163WP0809X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult