Healthcare Provider Details

I. General information

NPI: 1396379087
Provider Name (Legal Business Name): MEGAN LAGERVAL RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 OLD OAK ST
PEMBROKE MA
02359-1981
US

IV. Provider business mailing address

360 US HIGHWAY 1 BYP UNIT 102
PORTSMOUTH NH
03801-7105
US

V. Phone/Fax

Practice location:
  • Phone: 339-244-3033
  • Fax: 339-244-3005
Mailing address:
  • Phone: 603-410-6700
  • Fax: 603-319-8308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2279029
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: