Provider Demographics
NPI:1710253794
Name:CRAIN, MEGAN MELISSA (LPN)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:MELISSA
Last Name:CRAIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:147 LAKE SHORE RD
Mailing Address - Street 2:APT. 23B
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-3165
Mailing Address - Country:US
Mailing Address - Phone:631-780-2104
Mailing Address - Fax:631-981-0345
Practice Address - Street 1:147 LAKE SHORE RD
Practice Address - Street 2:APT. 23B
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-3165
Practice Address - Country:US
Practice Address - Phone:631-780-2104
Practice Address - Fax:631-981-0345
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307726164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse