Healthcare Provider Details

I. General information

NPI: 1093460800
Provider Name (Legal Business Name): MEGAN EDWARDS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/21/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 W PARK AVE
OCEAN NJ
07712-7272
US

IV. Provider business mailing address

111 ROUND RIDGE RD
MECHANICSBURG PA
17055-9202
US

V. Phone/Fax

Practice location:
  • Phone: 732-531-0010
  • Fax:
Mailing address:
  • Phone: 717-350-4115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ01274100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: