Provider Demographics
NPI:1508336439
Name:BURGESS, MEGAN S (FNP-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:S
Last Name:BURGESS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:S
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-3305
Mailing Address - Country:US
Mailing Address - Phone:810-648-2232
Mailing Address - Fax:
Practice Address - Street 1:75 DAWSON ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-3305
Practice Address - Country:US
Practice Address - Phone:810-648-2232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704259207NSA18113363LF0000X
MI4704259207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily