Healthcare Provider Details

I. General information

NPI: 1124514617
Provider Name (Legal Business Name): MEGHAN MARIE PARRY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2018
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 ENCINO PL NE STE D
ALBUQUERQUE NM
87102-2650
US

IV. Provider business mailing address

90 MONICA RD
LOS LUNAS NM
87031-7172
US

V. Phone/Fax

Practice location:
  • Phone: 505-224-7400
  • Fax: 505-224-7404
Mailing address:
  • Phone: 505-710-2260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53105
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: