Provider Demographics
NPI:1053662338
Name:MCGONIGAL HUSER, MEGHAN C
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:C
Last Name:MCGONIGAL HUSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:C
Other - Last Name:MCGONIGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:355 WESTFIELD RD
Mailing Address - Street 2:STE 120
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1443
Mailing Address - Country:US
Mailing Address - Phone:317-776-8748
Mailing Address - Fax:
Practice Address - Street 1:355 WESTFIELD RD
Practice Address - Street 2:STE 120
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1443
Practice Address - Country:US
Practice Address - Phone:317-776-8748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001441A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant