Healthcare Provider Details

I. General information

NPI: 1144758178
Provider Name (Legal Business Name): MEGAN MARION LYGHT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2017
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 DEMING WAY
MIDDLETON WI
53562-5512
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-824-6160
  • Fax: 608-827-3040
Mailing address:
  • Phone: 608-829-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4126
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: