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NPI Code Detail

MEDICARE: MEGAN M HARRIS RD

MEDICARE: MEGAN M HARRIS RD
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
1133V00000XRegistered Dietitian1578WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811298508
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN M HARRIS RD
Provider Business Mailing Address
First Line : 1160 KEPLER DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-8321
Country : US
Telephone Number : 920-288-5500
Fax Number :
Provider Business Practice Location Address
First Line : 2845 GREENBRIER RD
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-6519
Country : US
Telephone Number : 920-288-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2010
Last Update Date : 06/12/2026

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