MEDICARE: MR. JOHN ROBERT MEEKER 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	163WG0000X	General Practice Registered Nurse	102897	SC

General Provider Information

NPI Number	:	1689960627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN ROBERT MEEKER RN

Provider Business Mailing Address
First Line	:	1916 SAM RITTENBERG BLVD
Second Line	:	APT 1616
City	:	CHARLESTON
State	:	SC
Zip	:	29407-4826
Country	:	US
Telephone Number	:	609-254-7982
Fax Number	:

Provider Business Practice Location Address
First Line	:	1916 SAM RITTENBERG BLVD
Second Line	:	APT 1616
City	:	CHARLESTON
State	:	SC
Zip	:	29407-4826
Country	:	US
Telephone Number	:	609-254-7982
Fax Number	:

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

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	06/28/2011

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