MEDICARE: MEGAN VETTER

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1548656051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN VETTER

Provider Business Mailing Address
First Line	:	1 W FIRESTORM WAY
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-3216
Country	:	US
Telephone Number	:	623-385-9543
Fax Number	:

Provider Business Practice Location Address
First Line	:	61 FOSTER CANYON RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-6195
Country	:	US
Telephone Number	:	623-385-9543
Fax Number	:

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

Provider Enumeration Date	:	04/10/2015
Last Update Date	:	09/21/2022

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Directions to “ MEGAN VETTER ” Practice Location

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