Healthcare Provider Details

I. General information

NPI: 1538823398
Provider Name (Legal Business Name): MEGHAN CASSIDY CROTTY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER ST RM 2303
SAN FRANCISCO CA
94108-4201
US

IV. Provider business mailing address

8 SWIFT CT
MILL VALLEY CA
94941-2223
US

V. Phone/Fax

Practice location:
  • Phone: 415-434-8858
  • Fax: 415-434-8004
Mailing address:
  • Phone: 978-895-7351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028123
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95227235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: