=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851283766
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGHAN MARIE MUNDY NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2025
-----------------------------------------------------
Last Update Date | 07/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 UNIVERSITY AVE
-----------------------------------------------------
City | WESTWOOD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02090-2333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-613-8150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 51 PEABODY DR
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03833-6424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-418-5119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | RN2372907
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------