Healthcare Provider Details

I. General information

NPI: 1518475284
Provider Name (Legal Business Name): MEGAN MARIE MCCLEEREY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

2412 GRAND RIVER DR
DES MOINES IA
50320-2831
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-5000
  • Fax:
Mailing address:
  • Phone: 515-418-8661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License Number165642
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: