MEDICARE: MRS. MEGAN ELIZABETH HUSTED CNP

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	COA.13901-NP	OH

General Provider Information

NPI Number	:	1821342304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN ELIZABETH HUSTED CNP

Provider Business Mailing Address
First Line	:	4256 FULTON DR NW
Second Line	:	SUITE A
City	:	CANTON
State	:	OH
Zip	:	44718-2879
Country	:	US
Telephone Number	:	330-493-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	4256 FULTON DR NW
Second Line	:	SUITE A
City	:	CANTON
State	:	OH
Zip	:	44718-2879
Country	:	US
Telephone Number	:	330-493-3800
Fax Number	:

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

Provider Enumeration Date	:	11/05/2012
Last Update Date	:	10/07/2013

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