Healthcare Provider Details

I. General information

NPI: 1376901405
Provider Name (Legal Business Name): MRS. MEGAN BRADSHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN MAXFIELD FNP-C

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEMORIAL SQUARE SUITE 305
GREENFIELD IN
46140-2835
US

IV. Provider business mailing address

901 GONDOLA RUN
GREENFIELD IN
46140-7253
US

V. Phone/Fax

Practice location:
  • Phone: 317-468-6274
  • Fax: 317-468-6275
Mailing address:
  • Phone: 317-695-2456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28164116A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006557A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: