Healthcare Provider Details

I. General information

NPI: 1982113254
Provider Name (Legal Business Name): MEGAN REILLY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 12/13/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 JEFFERSON AVE STE 305
SCRANTON PA
18510-1639
US

IV. Provider business mailing address

746 JEFFERSON AVE STE 305
SCRANTON PA
18510-1639
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-1776
  • Fax: 570-207-1910
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP017922
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: