Healthcare Provider Details

I. General information

NPI: 1538496104
Provider Name (Legal Business Name): MEGAN DUNN-MCDERMOTT GREEN MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS WAY
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

421 WALNUT ST
LITTLE ROCK AR
72205-4041
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-2601
  • Fax:
Mailing address:
  • Phone: 501-364-2601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number977202
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: