Healthcare Provider Details

I. General information

NPI: 1881465920
Provider Name (Legal Business Name): MEGAN NOELLE BARTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W206N16106 STONEBROOK DR
JACKSON WI
53037-8935
US

IV. Provider business mailing address

514 RIVERVIEW AVE
WAUKESHA WI
53188-3631
US

V. Phone/Fax

Practice location:
  • Phone: 414-418-1204
  • Fax:
Mailing address:
  • Phone: 262-548-7212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: