Provider Demographics
NPI:1457814303
Name:MACDONALD, MEGAN (RN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6226
Mailing Address - Country:US
Mailing Address - Phone:401-742-4090
Mailing Address - Fax:
Practice Address - Street 1:28 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6226
Practice Address - Country:US
Practice Address - Phone:401-742-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2293694163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse