Healthcare Provider Details

I. General information

NPI: 1225457138
Provider Name (Legal Business Name): MEGHAN NIGHTINGALE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SUMMIT AVE 3RD FLOOR FAIN BUILDING
PROVIDENCE RI
02906-2853
US

IV. Provider business mailing address

164 SUMMIT AVE 3RD FLOOR FAIN BUILDING
PROVIDENCE RI
02906-2853
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-2920
  • Fax:
Mailing address:
  • Phone: 401-793-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNPP37821
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: