Healthcare Provider Details

I. General information

NPI: 1942880414
Provider Name (Legal Business Name): MEAGAN YAUILLA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 09/20/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 KNELLS RIDGE BLVD
CHESAPEAKE VA
23320-4885
US

IV. Provider business mailing address

108 KNELLS RIDGE BLVD STE 100
CHESAPEAKE VA
23320-4885
US

V. Phone/Fax

Practice location:
  • Phone: 757-436-1234
  • Fax:
Mailing address:
  • Phone: 757-436-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024181076
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024181073
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: