Provider Demographics
NPI:1609632702
Name:MAUPIN, MEGAN RENEA
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:RENEA
Last Name:MAUPIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:RENEA
Other - Last Name:HAGERDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5004 S 36TH WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-7404
Mailing Address - Country:US
Mailing Address - Phone:918-727-0154
Mailing Address - Fax:
Practice Address - Street 1:5004 S 36TH WEST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-7404
Practice Address - Country:US
Practice Address - Phone:918-727-0154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist