Healthcare Provider Details

I. General information

NPI: 1477123693
Provider Name (Legal Business Name): MRS. MEGAN ASHLEY MWANGI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN ASHLEY MCMULLEN APRN

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E MARION ST
SIGOURNEY IA
52591-1443
US

IV. Provider business mailing address

113 E MARION ST
SIGOURNEY IA
52591-1443
US

V. Phone/Fax

Practice location:
  • Phone: 641-541-4040
  • Fax: 641-541-4030
Mailing address:
  • Phone: 641-541-4040
  • Fax: 641-541-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA164327
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: