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General NPI Number Information
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NPI Number | 1891306817
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Entity Type | Individual
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Provider Name | MEGAN RICHARD AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 22 BRAMHALL ST
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City | PORTLAND
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State | ME
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Zip | 04102-3134
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Country | US
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Telephone | 207-662-2414
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Fax |
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Provider Business Mailing Address
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Address Line | 2276 ROXBURY RD
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City | ROXBURY
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State | ME
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Zip | 04275-3116
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Country | US
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Telephone | 207-357-3326
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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 | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | CNP201199
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CNP201199
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License Number State | ME
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