MEDICARE: MEGHAN TRACEWSKI CPNP

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	280040	MA
2	363L00000X	Nurse Practitioner	RN218122	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588813307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN TRACEWSKI CPNP

Provider Business Mailing Address
First Line	:	1001 JOHNSON FY RD NE APT 36
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1605
Country	:	US
Telephone Number	:	404-785-0369
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-2959
Country	:	US
Telephone Number	:	404-785-0369
Fax Number	:

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

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	03/18/2022

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