Provider Demographics
NPI:1255300018
Name:FISH, MEGAN R (NP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:R
Last Name:FISH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:RENEE
Other - Last Name:MUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP
Mailing Address - Street 1:6911 E US HIGHWAY 36
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8926
Mailing Address - Country:US
Mailing Address - Phone:317-272-7500
Mailing Address - Fax:317-272-7515
Practice Address - Street 1:6911 E US HIGHWAY 36
Practice Address - Street 2:SUITE 1100
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8926
Practice Address - Country:US
Practice Address - Phone:317-272-7500
Practice Address - Fax:317-272-7515
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002146A363LW0102X
IN71002146363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200821500Medicaid
INQ60586Medicare UPIN
INM400023200Medicare PIN
IN200821500Medicaid