Healthcare Provider Details

I. General information

NPI: 1205410164
Provider Name (Legal Business Name): MAYGAN MEAGHER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 ODLIN RD
BANGOR ME
04401-6709
US

IV. Provider business mailing address

689 ODLIN RD
BANGOR ME
04401-6709
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-6800
  • Fax:
Mailing address:
  • Phone: 207-947-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN64938
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: