Healthcare Provider Details

I. General information

NPI: 1477855633
Provider Name (Legal Business Name): MEGHAN ANN MCDONALD APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2010
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 MULLICA HILL RD STE 300
MULLICA HILL NJ
08062
US

IV. Provider business mailing address

1120 DELSEA DR N
GLASSBORO NJ
08028-1444
US

V. Phone/Fax

Practice location:
  • Phone: 856-508-3575
  • Fax: 856-221-4101
Mailing address:
  • Phone: 856-205-7071
  • Fax: 856-205-0145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP011028
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLP-0000188
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00972000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: