Healthcare Provider Details

I. General information

NPI: 1568541704
Provider Name (Legal Business Name): MEAGAN AMY MATTESON RN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

21 CROSSROADS DR STE 200
OWINGS MILLS MD
21117-5483
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-2500
  • Fax:
Mailing address:
  • Phone: 410-581-8140
  • Fax: 410-356-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR261162
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: