Healthcare Provider Details

I. General information

NPI: 1306184023
Provider Name (Legal Business Name): MEGHAN K FAULKNER CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ROBERT WOOD JOHNSON PL BMSCH-PEDIATRIC GENERAL SURGERY
NEW BRUNSWICK NJ
08901-1928
US

IV. Provider business mailing address

6 COLBY LN
HAZLET NJ
07730-2306
US

V. Phone/Fax

Practice location:
  • Phone: 732-672-2974
  • Fax:
Mailing address:
  • Phone: 732-861-7867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number430723-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ00554500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberSP012568
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: