MEDICARE: MEGHAN CASSIDY FONTAINE 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	95227235	CA
2	363LF0000X	Family Nurse Practitioner	95028123	CA

General Provider Information

NPI Number	:	1538823398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN CASSIDY FONTAINE RN

Provider Business Mailing Address
First Line	:	8 SWIFT CT
Second Line	:
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-2223
Country	:	US
Telephone Number	:	978-895-7351
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 SUTTER ST RM 2303
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-4201
Country	:	US
Telephone Number	:	415-434-8858
Fax Number	:	415-434-8004

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

Provider Enumeration Date	:	10/27/2021
Last Update Date	:	12/20/2023

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