MEDICARE: MEGAN MARTIN RN

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	163W00000X	Registered Nurse	2016026758	MO

General Provider Information

NPI Number	:	1053032763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MARTIN RN

Provider Business Mailing Address
First Line	:	2932 N 22ND PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7809
Country	:	US
Telephone Number	:	314-304-1214
Fax Number	:

Provider Business Practice Location Address
First Line	:	2932 N 22ND PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7809
Country	:	US
Telephone Number	:	314-304-1214
Fax Number	:

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

Provider Enumeration Date	:	09/09/2022
Last Update Date	:	09/09/2022

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