Provider Demographics
NPI:1427414572
Name:BUENTELLO, MEGAN CAROLYN (FNP)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:CAROLYN
Last Name:BUENTELLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 KIRKWOOD HWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-4917
Mailing Address - Country:US
Mailing Address - Phone:302-633-5364
Mailing Address - Fax:302-633-5557
Practice Address - Street 1:3801 ROUTE 9 S STE 2
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242-1915
Practice Address - Country:US
Practice Address - Phone:800-461-8262
Practice Address - Fax:609-888-4161
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015362363LF0000X
TXAP131304363LF0000X
NJ26NJ01004400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily