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NPI Code Detail

MEDICARE: MEAGAN GATES APRN

MEDICARE: MEAGAN GATES APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner12.008790CT

General Provider Information

NPI Number : 1013543792
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEAGAN GATES APRN
Provider Business Mailing Address
First Line : 189 WHISTLE TOWN RD
Second Line :
City : EAST LYME
State : CT
Zip : 06333-1031
Country : US
Telephone Number : 413-330-5419
Fax Number :
Provider Business Practice Location Address
First Line : 372 W MAIN ST
Second Line :
City : NORWICH
State : CT
Zip : 06360-5415
Country : US
Telephone Number : 860-887-5970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2020
Last Update Date : 12/18/2021

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