Healthcare Provider Details

I. General information

NPI: 1609248335
Provider Name (Legal Business Name): MEGAN MCQUEEN-STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1449 CLEVELAND AVE N
SAINT PAUL MN
55108-1413
US

IV. Provider business mailing address

1027 20TH AVE SE APT 2
MINNEAPOLIS MN
55414-2564
US

V. Phone/Fax

Practice location:
  • Phone: 651-645-5323
  • Fax:
Mailing address:
  • Phone: 651-645-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: