Healthcare Provider Details

I. General information

NPI: 1669761847
Provider Name (Legal Business Name): MEAGAN DUBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 AUTUMN LN
LEWISTON ME
04240-2234
US

IV. Provider business mailing address

23 AUTUMN LN
LEWISTON ME
04240-2234
US

V. Phone/Fax

Practice location:
  • Phone: 207-576-1651
  • Fax:
Mailing address:
  • Phone: 207-576-1651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number174H00000X
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: