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General NPI Number Information
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NPI Number | 1689137952
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Entity Type | Individual
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Provider Name | MEAGAN LEIGH HASTIE
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Gender | Female
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Dates
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Enumeration Date | 04/12/2019
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 1600 W 24TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-1499
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Country | US
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Telephone | 719-650-5651
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 846
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City | GREEN MOUNTAIN FALLS
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State | CO
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Zip | 80819-0846
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Country | US
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Telephone | 719-650-5651
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APN.0997324-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.0204928
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License Number State | CO
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