Healthcare Provider Details

I. General information

NPI: 1245401751
Provider Name (Legal Business Name): MEAGHAN RUDOLPH PCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 STRATFORD RD
MELROSE MA
02176
US

IV. Provider business mailing address

11 STRATFORD RD
MELROSE MA
02176-3510
US

V. Phone/Fax

Practice location:
  • Phone: 781-620-0085
  • Fax:
Mailing address:
  • Phone: 781-620-0085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number261318
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN261318
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: