Healthcare Provider Details

I. General information

NPI: 1003116807
Provider Name (Legal Business Name): MEGAN FOREMAN FOUREMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5213 S ALSTON AVE
DURHAM NC
27713-4430
US

IV. Provider business mailing address

5213 S ALSTON AVE
DURHAM NC
27713-4430
US

V. Phone/Fax

Practice location:
  • Phone: 919-620-4917
  • Fax: 919-620-4921
Mailing address:
  • Phone: 919-620-4917
  • Fax: 919-620-4921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number172314
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number172314
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: