Healthcare Provider Details

I. General information

NPI: 1922546647
Provider Name (Legal Business Name): MEGAN ASHLINE NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN SIMMONS

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E BANNOCK ST
BOISE ID
83712-6241
US

IV. Provider business mailing address

4408 W CLARK CIR
BOISE ID
83705-2001
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-2088
  • Fax: 208-381-2893
Mailing address:
  • Phone: 281-660-5864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number53463
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: