MEDICARE: MEGAN EMILY WYNKOOP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	089100-21	NH
2	163W00000X	Registered Nurse	RN2382921	MA

General Provider Information

NPI Number	:	1033826748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN EMILY WYNKOOP

Provider Business Mailing Address
First Line	:	345 CILLEY RD STE 1
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03103-4500
Country	:	US
Telephone Number	:	603-338-0033
Fax Number	:

Provider Business Practice Location Address
First Line	:	345 CILLEY RD STE 1
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03103-4500
Country	:	US
Telephone Number	:	603-338-0033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2022
Last Update Date	:	12/19/2025

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