Provider Demographics
NPI:1417982257
Name:MEAGHER, ELAINE R (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:R
Last Name:MEAGHER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 ARBUTUS RD
Mailing Address - Street 2:
Mailing Address - City:SANBORNVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03872-4139
Mailing Address - Country:US
Mailing Address - Phone:603-522-6586
Mailing Address - Fax:
Practice Address - Street 1:133 ORNAC
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4169
Practice Address - Country:US
Practice Address - Phone:978-287-3162
Practice Address - Fax:978-287-3659
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA91806367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA91806OtherNURSE'S LICENSE
MA91806OtherNURSE'S LICENSE