Healthcare Provider Details

I. General information

NPI: 1710577846
Provider Name (Legal Business Name): MEGHAN MUNIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 MAIN ST
WALTHAM MA
02451-0602
US

IV. Provider business mailing address

665 MAIN ST
WALTHAM MA
02451-0602
US

V. Phone/Fax

Practice location:
  • Phone: 978-390-0582
  • Fax:
Mailing address:
  • Phone: 978-390-0582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2309046
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: