Provider Demographics
NPI:1508388844
Name:PURCELL, MEGAN LYNN (BS)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LYNN
Last Name:PURCELL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 WINSTON DR STE 129
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5769
Mailing Address - Country:US
Mailing Address - Phone:314-602-2230
Mailing Address - Fax:
Practice Address - Street 1:79 WINSTON DR STE 129
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5769
Practice Address - Country:US
Practice Address - Phone:314-602-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator