Provider Demographics
NPI:1629210521
Name:NETTERVILLE, MEGHAN NICOLE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:NICOLE
Last Name:NETTERVILLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:NICOLE
Other - Last Name:MAGGITTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2546 KNIGHTS ROAD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020
Mailing Address - Country:US
Mailing Address - Phone:215-245-8873
Mailing Address - Fax:215-245-8895
Practice Address - Street 1:2546 KNIGHTS ROAD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020
Practice Address - Country:US
Practice Address - Phone:215-245-8873
Practice Address - Fax:215-245-8895
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010005363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics