Healthcare Provider Details

I. General information

NPI: 1750963955
Provider Name (Legal Business Name): MEREDITH JUNE KOCAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 COURT DR
GASTONIA NC
28054-2140
US

IV. Provider business mailing address

2080 W ARLINGTON BLVD STE B
GREENVILLE NC
27834-3770
US

V. Phone/Fax

Practice location:
  • Phone: 704-864-8772
  • Fax: 704-866-7853
Mailing address:
  • Phone: 252-752-2140
  • Fax: 252-689-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number133596
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: