Provider Demographics
NPI:1518550136
Name:ALTHOFF, MEAGAN LYNNE (NP)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:LYNNE
Last Name:ALTHOFF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 E INDIANA ST STE 103
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7448
Mailing Address - Country:US
Mailing Address - Phone:813-401-8008
Mailing Address - Fax:812-401-8201
Practice Address - Street 1:7300 E INDIANA ST STE 103
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7448
Practice Address - Country:US
Practice Address - Phone:812-401-8008
Practice Address - Fax:812-401-8208
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010758A363L00000X, 163WP0808X
IL71010758A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71010758AOtherLICENSE