Provider Demographics
NPI:1194005017
Name:PIETRASIAK, MEAGAN EMILY (NP)
Entity Type:Individual
Prefix:MS
First Name:MEAGAN
Middle Name:EMILY
Last Name:PIETRASIAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:
Other - Last Name:BOWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:55 FOGG RD
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190
Mailing Address - Country:US
Mailing Address - Phone:781-624-8719
Mailing Address - Fax:781-624-6730
Practice Address - Street 1:21 HIGHLAND AVE
Practice Address - Street 2:STE 24
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3872
Practice Address - Country:US
Practice Address - Phone:978-462-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2258403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily