Provider Demographics
NPI:1396379087
Name:LAGERVAL, MEGAN (RN, BSN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:LAGERVAL
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 OLD OAK ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1981
Mailing Address - Country:US
Mailing Address - Phone:339-244-3033
Mailing Address - Fax:
Practice Address - Street 1:296 OLD OAK ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1981
Practice Address - Country:US
Practice Address - Phone:339-244-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2279029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily