Healthcare Provider Details

I. General information

NPI: 1710726997
Provider Name (Legal Business Name): MEGAN WALLWORK BENTON DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EDGEWOOD DRIVE EXT
TRANSFER PA
16154-1817
US

IV. Provider business mailing address

63 PITT ST
SHARON PA
16146-2102
US

V. Phone/Fax

Practice location:
  • Phone: 724-962-3553
  • Fax: 724-962-3630
Mailing address:
  • Phone: 724-962-3553
  • Fax: 724-962-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN615578
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP030127
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: