Provider Demographics
NPI:1730658089
Name:ALLSUP, MEGAN DAWN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:DAWN
Last Name:ALLSUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 MCDOUGAL ST
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-3143
Mailing Address - Country:US
Mailing Address - Phone:419-379-4948
Mailing Address - Fax:
Practice Address - Street 1:924 MCDOUGAL ST
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-3143
Practice Address - Country:US
Practice Address - Phone:419-379-4948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401984490717374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide