1861724379 NPI number — MRS. MEGAN LORRAINE ATKINSON FNP

Table of content: MRS. MEGAN LORRAINE ATKINSON FNP (NPI 1861724379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861724379 NPI number — MRS. MEGAN LORRAINE ATKINSON FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATKINSON
Provider First Name:
MEGAN
Provider Middle Name:
LORRAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUTTERER
Provider Other First Name:
MEGAN
Provider Other Middle Name:
LORRAINE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861724379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7822 SALT SPRINGS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13066-9610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-663-5215
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 MERIDIAN CENTRE BLVD
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14618-3981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-481-3427
Provider Business Practice Location Address Fax Number:
585-463-3105
Provider Enumeration Date:
02/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  567348-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: F337360 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03194612 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com