Healthcare Provider Details

I. General information

NPI: 1902294689
Provider Name (Legal Business Name): MEGAN P FILLMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN P RYAN

II. Dates (important events)

Enumeration Date: 01/02/2015
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 W HIGH ST
BRYAN OH
43506-1690
US

IV. Provider business mailing address

433 W HIGH ST
BRYAN OH
43506-1690
US

V. Phone/Fax

Practice location:
  • Phone: 419-636-1131
  • Fax: 419-636-3100
Mailing address:
  • Phone: 419-636-1131
  • Fax: 419-636-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN330331
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28213611A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.16975
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: