Provider Demographics
NPI:1679819064
Name:MANSFIELD, MEAGAN MCBRIDE (RN)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:MCBRIDE
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:LEE
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6750 OLD TIPTON RD
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-4729
Mailing Address - Country:US
Mailing Address - Phone:901-833-2443
Mailing Address - Fax:
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000181407163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse