Provider Demographics
NPI:1790240349
Name:BLACK, MEAGHAN ELIZABETH (LPN)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:ELIZABETH
Last Name:BLACK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 NICKERSON ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-5655
Mailing Address - Country:US
Mailing Address - Phone:508-415-8395
Mailing Address - Fax:
Practice Address - Street 1:28 NICKERSON ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-5655
Practice Address - Country:US
Practice Address - Phone:508-415-8395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN89378164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse