Provider Demographics
NPI:1891794533
Name:DOBLE, MEGAN GIOVANELLI (MSN, CRNP)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:GIOVANELLI
Last Name:DOBLE
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3420
Mailing Address - Country:US
Mailing Address - Phone:302-655-5822
Mailing Address - Fax:302-655-3541
Practice Address - Street 1:908 E 16TH ST STE B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-5145
Practice Address - Country:US
Practice Address - Phone:302-575-1414
Practice Address - Fax:302-575-1726
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000309363L00000X
PASP007287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001186642Medicaid
DEP58572Medicare UPIN
DE081803Medicare Oscar/Certification