Healthcare Provider Details

I. General information

NPI: 1679240972
Provider Name (Legal Business Name): MEGAN ELIZABETH GILMERE ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/24/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 10TH ST SE
CEDAR RAPIDS IA
52403-1251
US

IV. Provider business mailing address

289 WOODFIELD DR
TIFFIN IA
52340-4723
US

V. Phone/Fax

Practice location:
  • Phone: 319-461-3533
  • Fax:
Mailing address:
  • Phone: 319-461-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberH164554
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number119640
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: