Healthcare Provider Details

I. General information

NPI: 1457922072
Provider Name (Legal Business Name): MEAGHAN MAYDICK DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 12/14/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 CHUCH HILL ROAD SUITE 2A
MCKEES ROCKS PA
15136
US

IV. Provider business mailing address

12 VAN BUREN CIR
MC KEES ROCKS PA
15136-1797
US

V. Phone/Fax

Practice location:
  • Phone: 412-722-1003
  • Fax:
Mailing address:
  • Phone: 610-442-6039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP023825
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierSP023825
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCRNP LICENSE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: