Healthcare Provider Details

I. General information

NPI: 1639896483
Provider Name (Legal Business Name): MEAGAN PRIME APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BIDDLE AVE STE 200
NEWARK DE
19702-3972
US

IV. Provider business mailing address

300 BIDDLE AVE STE 200
NEWARK DE
19702-3972
US

V. Phone/Fax

Practice location:
  • Phone: 302-838-4750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0012202
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: