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General NPI Number Information
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NPI Number | 1811421704
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Entity Type | Individual
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Provider Name | MEGHAN VUKORPA
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Gender | Female
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 07/21/2021
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Provider Practice Location Address
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Address Line | 1234 NAPIER AVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2112
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Country | US
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Telephone | 269-983-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 610 PARK ST # 3
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-1334
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 02006485A
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License Number State | IN
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