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General NPI Number Information
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NPI Number | 1447962337
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Entity Type | Individual
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Provider Name | MEGHAN THULL CST-SA
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Gender | Female
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Dates
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Enumeration Date | 12/22/2022
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Last Update Date | 12/22/2022
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Provider Practice Location Address
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Address Line | 4050 COON RAPIDS BLVD NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-2522
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Country | US
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Telephone | 763-236-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 21540 LINNET ST NW
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City | OAK GROVE
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State | MN
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Zip | 55011-4802
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Country | US
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Telephone | 952-412-6113
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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 | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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