MEDICARE: MEGAN MOUSER NP-C

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	363L00000X	Nurse Practitioner	4704257340	MI

General Provider Information

NPI Number	:	1134529993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MOUSER NP-C

Provider Business Mailing Address
First Line	:	5900 BYRON CENTER AVE SW
Second Line	:	MEDICAL ADMINISTRATION
City	:	WYOMING
State	:	MI
Zip	:	49519-9606
Country	:	US
Telephone Number	:	616-252-3243
Fax Number	:	616-252-0260

Provider Business Practice Location Address
First Line	:	7686 GEORGETOWN CENTER DR
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-8101
Country	:	US
Telephone Number	:	616-252-8600
Fax Number	:	616-252-8660

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

Provider Enumeration Date	:	08/29/2014
Last Update Date	:	12/05/2017

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