Healthcare Provider Details

I. General information

NPI: 1164378048
Provider Name (Legal Business Name): MEGHAN MACGILLIVRAY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 APPLETON ST APT 310
BOSTON MA
02116-5230
US

IV. Provider business mailing address

9 APPLETON ST APT 310
BOSTON MA
02116-5230
US

V. Phone/Fax

Practice location:
  • Phone: 207-939-3599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2308378
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: