Provider Demographics
NPI:1407596380
Name:LONDON, MAEGAN ALEIS (APRN)
Entity Type:Individual
Prefix:
First Name:MAEGAN
Middle Name:ALEIS
Last Name:LONDON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 ROGERS AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4067
Mailing Address - Country:US
Mailing Address - Phone:479-274-3200
Mailing Address - Fax:479-274-3289
Practice Address - Street 1:6801 ROGERS AVE FL 2
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4067
Practice Address - Country:US
Practice Address - Phone:479-274-3200
Practice Address - Fax:479-274-3289
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR219258363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology