Provider Demographics
NPI:1548918899
Name:MCNULTY, AIMEE RAE (NP)
Entity type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:RAE
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:AIMEE
Other - Middle Name:RAE
Other - Last Name:TALLEUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2055 SAVIERS RD STE A
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-3608
Mailing Address - Country:US
Mailing Address - Phone:805-483-2253
Mailing Address - Fax:
Practice Address - Street 1:2055 SAVIERS RD STE A
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-3608
Practice Address - Country:US
Practice Address - Phone:805-483-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019973363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily