Healthcare Provider Details

I. General information

NPI: 1548426497
Provider Name (Legal Business Name): MEAGAN MARIE JOHNSTON RN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEAGAN MARIE COOK RN

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 08/28/2021
Certification Date: 08/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E 13TH ST SUITE 110
LOVELAND CO
80537-5161
US

IV. Provider business mailing address

2555 E 13TH ST SUITE 110
LOVELAND CO
80537-5161
US

V. Phone/Fax

Practice location:
  • Phone: 970-461-6140
  • Fax:
Mailing address:
  • Phone: 970-820-6140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704248609
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN.0185334
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704248609
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0990441-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: