Provider Demographics
NPI:1659043412
Name:ALTENBURG, MEREDITH (APRN)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:ALTENBURG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CONGRESS ST S
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-1836
Mailing Address - Country:US
Mailing Address - Phone:973-713-8715
Mailing Address - Fax:
Practice Address - Street 1:111 CONGRESS ST S
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-1836
Practice Address - Country:US
Practice Address - Phone:973-713-8715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016539363LF0000X, 363LF0000X
SC25812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily