Healthcare Provider Details

I. General information

NPI: 1588853139
Provider Name (Legal Business Name): MICHAEL PAUL MEEGAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SHUFELT RD
SOUTH WALPOLE MA
02071-1051
US

IV. Provider business mailing address

2 SHUFELT RD
SOUTH WALPOLE MA
02071-1051
US

V. Phone/Fax

Practice location:
  • Phone: 508-668-3609
  • Fax:
Mailing address:
  • Phone: 508-668-3609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number213132
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: