Healthcare Provider Details

I. General information

NPI: 1174207757
Provider Name (Legal Business Name): MEGAN ANN HARTSELL MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN ROSEBERRY, WARNER

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 HOBSON RD
FORT WAYNE IN
46805-1617
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-373-9300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number71013619A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: