Provider Demographics
NPI:1568541704
Name:MATTESON, MEAGAN AMY (RN, CRNP)
Entity Type:Individual
Prefix:MS
First Name:MEAGAN
Middle Name:AMY
Last Name:MATTESON
Suffix:
Gender:F
Credentials:RN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CROSSROADS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5483
Mailing Address - Country:US
Mailing Address - Phone:410-581-8140
Mailing Address - Fax:410-356-0885
Practice Address - Street 1:21 CROSSROADS DR STE 200
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5483
Practice Address - Country:US
Practice Address - Phone:410-581-8140
Practice Address - Fax:410-356-0885
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR261162363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2747586Medicaid
OHMANP22202Medicare PIN