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General NPI Number Information
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NPI Number | 1568853216
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Entity Type | Individual
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Provider Name | MEGAN BUTCHER
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Gender | Female
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Dates
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Enumeration Date | 02/16/2015
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Last Update Date | 02/16/2015
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Provider Practice Location Address
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Address Line | 7916 W JEFFERSON BLVD SUITE 112
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City | FORT WAYNE
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State | IN
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Zip | 46804-4140
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Country | US
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Telephone | 260-969-7218
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Fax |
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Provider Business Mailing Address
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Address Line | 7803 PRESTON POINTE DR
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City | FORT WAYNE
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State | IN
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Zip | 46804-5705
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Country | US
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Telephone | 260-403-4485
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 28197696A
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License Number State | IN
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