Healthcare Provider Details

I. General information

NPI: 1134532229
Provider Name (Legal Business Name): MEGAN MALOUF R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 GORDON COOPER DR.
SHAWNEE OK
74801
US

IV. Provider business mailing address

31 CHEROKEE ST
SHAWNEE OK
74801-5561
US

V. Phone/Fax

Practice location:
  • Phone: 405-395-9303
  • Fax: 405-395-9305
Mailing address:
  • Phone: 405-395-9303
  • Fax: 405-395-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number109984
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: