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General NPI Number Information
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NPI Number | 1255166591
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Entity Type | Individual
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Provider Name | MEGAN NICOLE SHONGUT FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/05/2024
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 2391 COURT DR
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City | GASTONIA
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State | NC
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Zip | 28054-2196
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Country | US
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Telephone | 704-853-3330
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Fax |
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Provider Business Mailing Address
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Address Line | 8933 PENNEGROVE CIR
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City | CHARLOTTE
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State | NC
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Zip | 28214-8138
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Country | US
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Telephone | 336-457-3572
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5020803
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License Number State | NC
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