Provider Demographics
NPI:1407469463
Name:STATEN, MEGHAN (LPN)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:STATEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 SCHLUETER DR
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-7602
Mailing Address - Country:US
Mailing Address - Phone:845-380-0252
Mailing Address - Fax:
Practice Address - Street 1:181 SCHLUETER DR
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-7602
Practice Address - Country:US
Practice Address - Phone:845-380-0252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337684164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse