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General NPI Number Information
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NPI Number | 1467007989
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Entity Type | Individual
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Provider Name | MEGAN RACHEL DARA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/02/2019
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Last Update Date | 08/02/2019
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Provider Practice Location Address
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Address Line | 51160 GRATIOT AVE
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City | CHESTERFIELD
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State | MI
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Zip | 48051-2035
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Country | US
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Telephone | 586-221-1805
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Fax |
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Provider Business Mailing Address
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Address Line | 4060 ROCHESTER RD
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City | TROY
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State | MI
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Zip | 48085-4923
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704299401
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License Number State | MI
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