Provider Demographics
NPI:1336120146
Name:HANDLEY, MEGEN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MEGEN
Middle Name:
Last Name:HANDLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 JOHNSONBURG RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ST MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3483
Mailing Address - Country:US
Mailing Address - Phone:814-834-1686
Mailing Address - Fax:814-834-6291
Practice Address - Street 1:761 JOHNSONBURG RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ST MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3483
Practice Address - Country:US
Practice Address - Phone:814-834-1686
Practice Address - Fax:814-834-6291
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007940363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
073166Medicare ID - Type Unspecified
P97986Medicare UPIN