Healthcare Provider Details

I. General information

NPI: 1386662674
Provider Name (Legal Business Name): MEGAN MOORE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN OBRIEN CRNA

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SPRUCE STREET
PHILADELPHIA PA
19107-6130
US

IV. Provider business mailing address

804 SCOTT NIXON MEMORIAL DRIVE
AUGUSTA GA
30907-2464
US

V. Phone/Fax

Practice location:
  • Phone: 267-322-7700
  • Fax: 267-322-7705
Mailing address:
  • Phone: 800-394-4445
  • Fax: 706-650-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN506685L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: