Healthcare Provider Details

I. General information

NPI: 1669852604
Provider Name (Legal Business Name): MEGAN WEISS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 E STATE ST
ATHENS OH
45701-2138
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1562
US

V. Phone/Fax

Practice location:
  • Phone: 855-446-5937
  • Fax: 740-446-5982
Mailing address:
  • Phone: 740-446-5000
  • Fax: 740-446-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN75911-CRNA
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019723
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: