Provider Demographics
NPI:1912542846
Name:MOBLEY, MEGAN MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:ECONOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:77 LINCOLN BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-7422
Mailing Address - Country:US
Mailing Address - Phone:916-258-2751
Mailing Address - Fax:
Practice Address - Street 1:77 LINCOLN BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-7422
Practice Address - Country:US
Practice Address - Phone:916-258-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95013250OtherCALIFORNIA NURSE PRACTITIONER FURNISHING NUMBER
CA95013250OtherCALIFORNIA NURSE PRACTITIONER LICENSE NUMBER