1477200434 NPI number — MEAGAN LUTICIA ESTER LVN

Table of content: MEAGAN LUTICIA ESTER LVN (NPI 1477200434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477200434 NPI number — MEAGAN LUTICIA ESTER LVN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESTER
Provider First Name:
MEAGAN
Provider Middle Name:
LUTICIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LVN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRAVY
Provider Other First Name:
MEAGAN
Provider Other Middle Name:
LUTICIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LVN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1477200434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7605 FRANKLIN LAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILSBEE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77656-9507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7605 FRANKLIN LAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILSBEE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77656-9507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-499-1570
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2022

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: 164X00000X , with the licence number:  1015551 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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