Healthcare Provider Details

I. General information

NPI: 1316979248
Provider Name (Legal Business Name): MEGAN MACCARTHY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN HOTCHKISS PA-C

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 DICKINSON RD STE 17B
DE PERE WI
54115-4056
US

IV. Provider business mailing address

2200 DICKINSON RD STE 17B
DE PERE WI
54115-4056
US

V. Phone/Fax

Practice location:
  • Phone: 920-965-1234
  • Fax: 920-965-1232
Mailing address:
  • Phone: 920-965-1234
  • Fax: 920-965-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3477-23
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3477
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: