1558837054 NPI number — MISS MEGAN LINDSEY NORTH GOETZ CRNP

Table of content: (NPI 1356673040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558837054 NPI number — MISS MEGAN LINDSEY NORTH GOETZ CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOETZ
Provider First Name:
MEGAN
Provider Middle Name:
LINDSEY NORTH
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558837054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3140A CAHABA HEIGHTS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VESTAVIA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35243-5243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-967-9248
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4317 DOLLY RIDGE RD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VESTAVIA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35243-5745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-971-1672
Provider Business Practice Location Address Fax Number:
833-509-2275
Provider Enumeration Date:
10/23/2018

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: 363LF0000X , with the licence number:  1-153524 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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