MEDICARE: MEGAN MARIE MCELROY-BOOSE

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
1	172A00000X	Driver

General Provider Information

NPI Number	:	1528794104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MARIE MCELROY-BOOSE

Provider Business Mailing Address
First Line	:	2971 N 61ST ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1406
Country	:	US
Telephone Number	:	414-793-8545
Fax Number	:

Provider Business Practice Location Address
First Line	:	2971 N 61ST ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1406
Country	:	US
Telephone Number	:	414-793-8545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2022
Last Update Date	:	07/27/2022

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