Provider Demographics
NPI:1184674814
Name:BISE, MEGAN C (NP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:C
Last Name:BISE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 E. MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:OH
Mailing Address - Zip Code:43907
Mailing Address - Country:US
Mailing Address - Phone:740-942-6216
Mailing Address - Fax:740-942-6218
Practice Address - Street 1:943 E. MARKET STREET
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907
Practice Address - Country:US
Practice Address - Phone:740-942-6216
Practice Address - Fax:740-942-6218
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV62357363LA2200X
OHAPRN.CNP.06984363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0135099Medicaid