Provider Demographics
NPI:1003410242
Name:GOULD, MEGAN ROSE (LPN)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:ROSE
Last Name:GOULD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17603 SANDY CREEK VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9357
Mailing Address - Country:US
Mailing Address - Phone:315-804-7122
Mailing Address - Fax:
Practice Address - Street 1:738 HIGH ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NY
Practice Address - Zip Code:13624-1510
Practice Address - Country:US
Practice Address - Phone:315-771-9774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326025164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse