Healthcare Provider Details

I. General information

NPI: 1730550880
Provider Name (Legal Business Name): LETITIA MEGLAN CRNA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9551 PASEO DEL NORTE NE
ALBUQUERQUE NM
87122-2975
US

IV. Provider business mailing address

8915 N OAKLAND CT NE
ALBUQUERQUE NM
87122-3968
US

V. Phone/Fax

Practice location:
  • Phone: 505-350-6717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberCRNA00580
License Number StateNM

VIII. Authorized Official

Name: LETITIA MEGLAN
Title or Position: OWNER
Credential: CRNA
Phone: 505-350-6717