Provider Demographics
NPI:1164571626
Name:ROTTERMAN, MEGHANN M (CNP)
Entity Type:Individual
Prefix:
First Name:MEGHANN
Middle Name:M
Last Name:ROTTERMAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:MEGHANN
Other - Middle Name:A
Other - Last Name:MCHALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:30 E APPLE ST
Mailing Address - Street 2:STE 5254
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2939
Mailing Address - Country:US
Mailing Address - Phone:937-208-4200
Mailing Address - Fax:937-208-4205
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:STE 5254
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-4200
Practice Address - Fax:937-208-4205
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH317304163W00000X
OHNP-08970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3060155Medicaid
OH3060155Medicaid
OHH072890Medicare PIN