MEDICARE: MEAGHANN E DEASY FNP-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	363LF0000X	Family Nurse Practitioner	F03210426	WI

General Provider Information

NPI Number	:	1386211597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGHANN E DEASY FNP-C

Provider Business Mailing Address
First Line	:	230 N CHARLES ST APT 3
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53186-5556
Country	:	US
Telephone Number	:	262-719-1106
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 S 7TH ST STE 300
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-3538
Country	:	US
Telephone Number	:	414-645-8383
Fax Number	:

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

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	06/07/2021

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