Healthcare Provider Details

I. General information

NPI: 1215272372
Provider Name (Legal Business Name): KIMBERLY A MEEGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 COUNTY ROAD D E APT 132
MAPLEWOOD MN
55109-5327
US

IV. Provider business mailing address

1695 COUNTY ROAD D E APT 132
MAPLEWOOD MN
55109-5327
US

V. Phone/Fax

Practice location:
  • Phone: 630-418-9116
  • Fax:
Mailing address:
  • Phone: 630-418-9116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: