Healthcare Provider Details

I. General information

NPI: 1811783442
Provider Name (Legal Business Name): MEIEO WASHBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 RIPPLING DR NW
MARIETTA GA
30064-1844
US

IV. Provider business mailing address

222 RIPPLING DR NW
MARIETTA GA
30064-1844
US

V. Phone/Fax

Practice location:
  • Phone: 801-550-2651
  • Fax:
Mailing address:
  • Phone: 801-550-2651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN61667572
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: