Healthcare Provider Details

I. General information

NPI: 1689354581
Provider Name (Legal Business Name): MEGHAN SHANLEY ROLSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 CHAPEL AVE W
CHERRY HILL NJ
08002-2233
US

IV. Provider business mailing address

311 GLENN AVE
LAWRENCEVILLE NJ
08648-3244
US

V. Phone/Fax

Practice location:
  • Phone: 609-850-8184
  • Fax:
Mailing address:
  • Phone: 609-850-8184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ14879100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP031526
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP031526
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ14879100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: