Healthcare Provider Details

I. General information

NPI: 1588813307
Provider Name (Legal Business Name): MEGHAN TRACEWSKI CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CLIFTON RD NE
ATLANTA GA
30322-2959
US

IV. Provider business mailing address

1001 JOHNSON FY RD NE APT 36
ATLANTA GA
30342-1605
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-0369
  • Fax:
Mailing address:
  • Phone: 404-785-0369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN218122
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number280040
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: